A.n.d.?

[one2one]

The physician's order sheets we use at our hospital have a space at the top for the physician to write in the pt's code status. One of the physician's recently wrote in "A.N.D." in this space. When asked what it meant, he said "Allow natural death". This is not an approved abbreviation at our facility. When asked exactly what he meant by that, he went into a 15 minute speech. In the end, the conclusion I came to was that the pt was to be a DNR. Have any of you seen this abbreviation used before? I'm not sure what the legal consequences would have been if the pt had coded and we followed the order and did nothing. I would like to hear your thoughts on this.

[Reigen]

I have never seen that particular abbreviation used before. Since it is not on your approved list to be used, your nurse manager of your unit should be able to ask/tell that physician to change that to an approved one. If he refuses, your nurse manager can take it to the cheif medical officer and have the CMO inform the physican what needs to be done.

I am glad that you did ask him what it stood for, I hope that you also docuemented that conversation in the patient's medical record /nurse's notes.

Reigen

[Antikigirl, ASN, RN]

We have a very strong nursing department at our facility, and if it is not an approved abreviation and something was to go wrong...our hospital stands up for the nurses. But typically if we see an abreviation we do not know...we call the MD (or if we can't read their writing).

The approved is DNR, DNI (do not intubate), FULL CODE (must be written out fully on that one) or in cases we do have to refer to a POLST or Advanced directives..and that will be labled "see advanced directives" and we must check on that each start of shift for all pts. I take quick notes of that on my assignment sheet just in case (like okay you can shock but no IV's...yeah alright not too smart but okay).

[maolin]

My mentor is actually a strong advocate of adopting this term to replace "DNR" in my local medical community. It's not yet a widely used or approved abbreviation from a documentation standpoint. She is working hard to educate and change attitudes regarding death and dying and is a champion of AND. I think that Allow Natural Death has a much more dignified, solemn and peaceful feel to it - as it should be when patients and families arrive at this point in the life cycle. Do Not Resuscitate tends to sound harsh and almost neglectful.

If AND is not an approved abbreviation, then it should be corrected to the proper legally approved term in documentation. Perhaps this doctor can facilitate a new policy regarding acceptable code status terminology.

[Altra, BSN, RN]

I have seen this term before, Allow Natural Death. I rather think I like it better than Do Not Resuscitate. But if it is not an approved term at your facility, I'm sure the doc can understand that, and use the appropriate DNR term.