DNR bracelet with DNR written on it. HIPAA???

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    I was at a committee meeting today. We discussed color coded bracelets that our hospital is considering. One of them is a blue bracelet for DNR patients. It was mentioned that they also want to write 'DNR' on it.

    I feel strongly that this is a violation of patient privacy. It advertises to any visitor that the patient has made the decision to be a DNR. I was very vocal about my feelings regarding this. I was the only bedside nurse in the meeting. I think this is basically 'outing' the patient to the world. Many members of the public know what DNR means. It can cause dissension between family members, it can cause people with more extreme views regarding extension of life to make trouble for decision making family members, and it's making visable to any visitor the private information of the patient.

    I feel strongly that a blue bracelet should suffice to communicate with members of the healthcare team and that adding DNR to the bracelet is wrong.

    Any imput on this would be appreciated.
    lamazeteacher likes this.
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  3. 87 Comments so far...

  4. 1
    I agree. The color should be enough.
    FireStarterRN likes this.
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    Not to be rude but...so what? What's wrong with patients making their wishes known to the entire world? I would think that's what the patient wants, that if they were to code in such a manner that required intubation or "heroic measures," they would want the world to know to let them go peacefully without the threat of trauma or lengthening their life with no added quality to it. If those were my wishes and my ability to make this decision while of sound mind were all I had left, and my will and legacy depended on it, I would want everyone to know it, regardless of whether they were part of a health care team or not.
    Last edit by GregRN on Nov 29, '07
    Sugar Magnolia, hgrimmett, and jmgrn65 like this.
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    This would be a hospital policy to write DNR on the blue band. Therefore, it's not the patient's choice to tell all his/her visitors that they are a DNR. If the patient wants to share this info with visitors, they certainly have that right. But, it should be their choice.

    With all this HIPAA talk, I can't believe they think it's our right to write DNR on a bracelet that will be seen by everyone.
    joprasklpn likes this.
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    Good Lord, do they think that a patient's end of life choices should be public info for all their visitors? Why not just leave a copy of their medical history, their meds and everything else, for the visitors to review!!!!
    Valerie Salva and joprasklpn like this.
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    I'm Australian, and we don't have HIPAA itself, but we do have privacy laws. Due to these laws, we cannot make any indication, even in 'code' like a coloured bracelet, that a patient has decided to become NFR (not for resus). We have the NFR order in the notes and it is handed over each shift so the nurse caring for the patient is aware, but we don't make any other indication.

    In regards to the bracelets, even if you don't have DNR on them, what would you say to a family member if they asked you why their mum or dad had this extra blue bracelet on?
  9. 1
    Greg, not everyone wants it known what their code status is. I do applaud your decision to be upfront about it but.......It may go against religious beliefs or a loved ones wants/needs for the patient (not willing to let go, etc.) Also there are MANY disfunctional families out there that would have a field day with knowing that.

    I would say that I would want my code status private as I could see my kids fighting amongst each other over the status. Best to avoid problems before they start.

    When my mom was dying, she chose DNR but did not want my gram to know (her mom) because she would have FLIPPED OUT. But the decision was my mom's and she was happy and at peace with it. Gram would have just caused a lot of grief for us and also headaches for the hospital staff had she known at the time.
    FireStarterRN likes this.
  10. 1
    Quote from GregRN
    Not to be rude but...so what? What's wrong with patients making their wishes known to the entire world? I would think that's what the patient wants, that if they were to code in such a manner that required intubation or "heroic measures," they would want the world to know to let them go peacefully without the threat of trauma or lengthening their life with no added quality to it. If those were my wishes and my ability to make this decision while of sound mind were all I had left, and my will and legacy depended on it, I would want everyone to know it, regardless of whether they were part of a health care team or not.
    What if the pt can't speak? If a visitor of another pt walks into the room (assuming you don't have private rooms) then they may see it as family who don't know that the pt is DNR. A stroke pt who can't speak doesn't have the option of voicing their wishes and concerns. We have to protect them. It is not a stranger's business nor an extended family member who hasn't seen the pt in 10 years business to know if the pt is a code or no code.

    If you, as a non-healthcare person (work with me here), walked into a room and saw that a pt had no hair or eyebrows, what would you think? You'd probably think they are receiving chemo and have cancer. What if you saw that they were DNR? You'd probably think that their cancer was end stage and they had no hope to live. I certainly wouldn't want to be dying and have some stranger say to another "Poor thing. She's DNR you know, she must be dying".

    I appreciate your honesty though.
    FireStarterRN likes this.
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    This is NOT a HIPAA violation...(think of I/O sheets, lab-draw sheets, charge sheets, etc that hang in the room...legally, it's akin to that.)
    However, ethically...it's stupid to write DNR on the bracelet. I agree with the OP, the colored band is appropriate and sufficient.
  12. 0
    The facility I work at, we use yellow DNR bracelets. On the bracelet, there are three types, DNR, DNR-CC and DNR-CCA. We are to use a hole puncher to punch out which one applies, and then apply to the pt. What would happen if someone that is might not be partaking in that patients care happens to witness them code... a blank bracelet may not make them aware of what their code status is and begin coding the person.


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