With-holding resuscitation on pt in the absense of a signed DNR order form? What?!

[Cat_RN]

This is something I would like clarified as a recent situation has drawn up some questions. I feel my DON is VERY in the wrong here. She is trying to tell us that here, in the state of FLORIDA, one does NOT need a YELLOW DNR order formed signed by the physician and the patient or DPOA to WITH-HOLD CPR on a pulseless pt. Nurses are having action taken against them because a pt was unsuccessfully coded who was supposedly a 'DNR', but her chart was absent of that signed YELLOW form. The DON told us that if the pt had a T.O. the doc's signature on it and that's it that it was sufficient enough to not code a pt.

I was ALWAYS taught that in the absence of that signed DNR form, you are to code any and every pt. She is trying to tell us that a T.O. signed by the doc is good enough not to perform CPR!!! I have never talked to anyone who would echo this statement! We all KNOW it has to be that yellow DNR form totally filed out in order NOT to code the pt. Are we all crazy?

There are so many things with wrong this.

Please help I need your input!

[LTCangel, ADN, BSN, LPN]

In our facility in WV a signed TO or a written and signd doctor's order is sufficient to make a pt a DNR. Sometimes we would get NH pts admitted and their DNR orders did not come with them. The admitting nurse always asks this question of every pt or family member. If I came across a pt who states they are a DNR but do not have their papers with them or a POA who states the same but has no papers than I would call the doctor to come and evaluate the situation. If he/she was not familiar with the patient he would come and talk with the pat and family members to determine the situation and then write a DNR order in the chart. If a telephone order was taken it needed to signed within 24 hours and Social Services is contacted to draw up official papers or the family would bring in the official papers. If the Nursing Home had neglected to send papers then we call and ask them to fax a copy for the chart. But in the meantime a signed TO or a written order for DNR is sufficient. It would be a horrible thing to code a pt who had requested wishes not to be resucitated. There are not any specific color of any DNR papers unless they are facility specific. A blue armband and a blue DNR sticker on the front of the chart, I believe are universal.:)

[AmericanRN]

i am in florida. the yellow paper is specific to the state of florida not a facility. your don had better re-read what the fl department of health states along with the statuate. we have a lot of dnrs in this state more so then many others due to our high geriatic population and its better to know then make guesses.

and if your facility needs to transport someone out ems will refuse to take them unless that dnr is on yellow paper. now it is allowable to have someone (say a relative) fax the dnr over to a facility but it would need to be recopied on yellow paper. thats not on opinion that is fl statuate.

http://www.doh.state.fl.us/demo/trauma/dnro.html#obtain

[color=#052a73]chapter 765 and [color=#052a73]chapter 401.45, florida statutes address end-of-life issues. chapter 64j-2.018, florida administrative code addresses the do not resuscitate order

[FancypantsRN]

I worked in Florida. In central Florida, they used only the yellow DNR forms. However, I did not see any such forms in south Florida. Hmmmm. Should I be glad I did not have a DNR expire while working in south Florida?

[MunoRN, RN]

So if your facility runs out of yellow paper everyone gets CPR whether they want it or not until the next Office Depot shipment comes in? Can you just use a yellow hi-lighter?

[Old.Timer]

So if your facility runs out of yellow paper everyone gets CPR whether they want it or not until the next Office Depot shipment comes in? Can you just use a yellow hi-lighter?

That was good......LLOOLL!

[CompleteUnknown]

So if your facility runs out of yellow paper everyone gets CPR whether they want it or not until the next Office Depot shipment comes in? Can you just use a yellow hi-lighter?

Hahahaha. I thought exactly the same thing!

[JenniferSews]

It depends on your state. In my state we use the MOST form, which is bright lime green. A verbal from the MD is sufficient, and a TO works just fine. We can also write "VO per X practioner" in the signature section until a practioner is able to sign. They recently adopted this form and system. Now a PA or NP can also sign, where before they could not, all positive changes if you ask the staff, patients and families. If a doc doesn't come in every day, a lot can happen between admission and their next visit. I'd hate to see a patient's wishes not respected because of a missed signature. Check your state regs.

[FancypantsRN]

So if your facility runs out of yellow paper everyone gets CPR whether they want it or not until the next Office Depot shipment comes in? Can you just use a yellow hi-lighter?

Yep, pretty much. It was the policy where I worked that we were not legally covered to honor the DNR unless it was on the provided DNR form. That's why the first thing I would do is call the hospitalist on duty to come sign the form if the pt said they were a DNR. Like I said, in south Florida, it wasn't that way - a simple DNR order written in the chart or a telephone order signed by 2 RN's was sufficient.

[AmericanRN]

So if your facility runs out of yellow paper everyone gets CPR whether they want it or not until the next Office Depot shipment comes in? Can you just use a yellow hi-lighter?

I actually saw a case manager run to Office Depot to buy yellow paper so we could transport a pt from the hospital back to their ALF. We giggled too until she & the social workers explained no one will be laughing if it ends up in court over a piece of freakin yellow paper. And when I worked in LTC they NEVER ran out of yellow paper. They literally had boxes of it stacked up in a supply room next to a copier.

Yellow paper yes, non rebreather masks for those full codes =good luck with that search.

[usalsfyre]

So you are saying in the case of a SIGNED ORDER for the pt to be DNR, the nurse should start performing CPR and contact the doctor for guidance? This doesn't make sense to me, if the MD already signed a DNR order why would you start CPR and call the doctor about whether or not you should be doing cpr?

Ideally, heck no, you don't start CPR. However, if there is question as to validity, ect as some people here are saying then you initiate resucitation until you can clear the situation up.

As to the "only on yellow paper" BS, sounds like a severe case of ignorance on the part of everyone involved to me. It can still be a copy, but it has to be on yellow paper? Stupid....

[AmericanRN]

Ideally, heck no, you don't start CPR. However, if there is question as to validity, ect as some people here are saying then you initiate resucitation until you can clear the situation up.

As to the "only on yellow paper" BS, sounds like a severe case of ignorance on the part of everyone involved to me. It can still be a copy, but it has to be on yellow paper? Stupid....

Everyone involved would be the entire legislative body in Florida and every single hospital, EMS provider, LTC, you name it. I posted the link in an earlier post the "yellow paper DNR" is state law not facility specific or a misintepretation of a policy. The Department of Health in Florida also states they will fax a person a DNR to be signed by an MD but that the person recieving the fax needs to put copy it on a yellow piece of paper. It goes on even further saying that any shade of yellow would be sufficient. Reality is if thats not done the DNR isn't valid regardless of what certain hospitals in some parts of FL are doing. Now I'm not saying the law shouldn't be challenged just pointing out that its state law not Hospital XYZ policy. There is no way any hospital in Florida is going to defend a nurse or a doctor if some DNR case gone haywire ends up in the state Supreme court.

[usalsfyre]

Everyone involved would be the entire legislative body in Florida and every single hospital, EMS provider, LTC, you name it. I posted the link in an earlier post the "yellow paper DNR" is state law not facility specific or a misintepretation of a policy. The Department of Health in Florida also states they will fax a person a DNR to be signed by an MD but that the person recieving the fax needs to put copy it on a yellow piece of paper. It goes on even further saying that any shade of yellow would be sufficient. Reality is if thats not done the DNR isn't valid regardless of what certain hospitals in some parts of FL are doing. Now I'm not saying the law shouldn't be challenged just pointing out that its state law not Hospital XYZ policy. There is no way any hospital in Florida is going to defend a nurse or a doctor if some DNR case gone haywire ends up in the state Supreme court.

Then yep, then all of the above are participating in complete and utter idiocy. Stuff like this is not about respecting the wishes of the patient, it's about beuracratic process and ensuring a mindless drone somewhere has boxes to check.