DNR orders

When I hit 80 I'm having it tattooed on my chest

I guess I am very lucky to work with a Dr. who explains everything to the pt. and the family. I have learned a lot from him and the way he presents the idea of code status to the pt and family. He does say to them "What would you like done if you heart stops and you stop breathing". He does go on to explain the steps taken and the fact that you (or your family member) are already gone when this takes place.
He also explains what happens if the pt. is "brought back" what happens then defined by thier age or condition. He wants a nurse by his side (not just to witness, but to assist him with understanding thier imput) . It does a lot to dispell the ideas most people have about CPR and live saving.

I *think* if someone performs resuscitation on someone who they know has a DNR then they can actually be charged with assault and battery. Although I must say, I don't see that actually happening very often.

I once had a patient who was a DNR and "saved" by a good intentioned passerby. He was a very angy, frustrated man. Bitter towards everyone related to healthcare. He had made his peace and was ready to go and was brought back.

Yes, I've seen the little old man as a full code and we worked for what seemed like an hour to bring him back, fly him out to a larger facility, then a week later shipped back to us to die in Hospice care. Sad

I have actually used the words "It's not like you see on TV in shows like ER when we code a patient" to family members when they ask. The first time, it just popped out, not the most tactfully either to my chagrin. However, the family was receptive to that statement and wanted to know just how it was different...and went on to become angry at "those people who make those shows" for the inaccuracies usually portrayed. I have come to use that situation as a building block for discussion with subsequent families..."I know most people just have a vague idea of what a code involves based on what they've seen on TV and in the movies, and that's usually not accurate. Why don't you tell me what your impression is of what occurs and we can figure out where you've been misinformed, so you can make the decision based on the facts."

We also have to ask about advanced directives with our admit paperwork, which gives a great opportunity to broach the subject with patients/families, and to explain the different levels of care available (medical management vs. comfort care). Thankfully, our hospitalist group (which sees on average 50-75% of our patients) is pretty good about listening to the nurses about this when we have suggestions for who would be open to DNR status.

I happen to enjoy this video about DNR-- I think in certain circumstances the message really applies.

It is rarely explained to patients well what DNR status is.

http://www.youtube.com/watch?v=OVx2mjjBvis

Wow! Thanks for sharing this.

Just having a living will and a DNR is not enough,i have an 86 yr old family member with both of these,and a partner with a POA who supported him,and when he requested palliative care after an obstruction,was denied palliative care,told he had no option but surgery,he also has diabetes/CHF/COPD/Vascular dementia/Peri[heral vascular disease and has been in severe chronic pain for 20 years,when he woke up from the surgery he again requested palliative care,and even though his primary doctor and his psychologist supported him,he was overruled by the surgeon.

Who signed the surgical consent form?