Advanced directive and CODE status

Daytonite, BSN, RN · Oct 21, 2007

First of all, it should have been addressed when they were admitted. This is a federal requirement and is a question that is included on the admission form.

Secondly, very simply ask, "Do you have an advanced directive?" "Do you know what I am talking about?" It gets easier to talk about each time you do it. Be aware that you have a responsibility to do this. It is required by federal law and is a JCAHO standard.

http://www2.edc.org/lastacts/archives/archivesJan99/decisiontree.pdf
http://www.jcrinc.com/4995/
http://www.clevelandclinic.org/bioethics/patients/adfaq.html - this pertains to residents of Ohio

By the way, do you have an advanced directive? You should. You never know. . .I was living in Missouri when the Karen Quinlan case was a full blown tragedy and I learned my lesson. I've had either a living will or advanced directive in place since then. Each state has specific laws in place with regard to these documents. Since I've been ill lately and hospitalized a couple of times I've had to make multiple copies of mine and have them ready for doctors, home health agencies and the hospitals. The question about having an advanced directive is the first question on the admission form at my local hospital.

Joni's Mom · Oct 21, 2007

Thank you for your response

So an advanced directive is not the same as a DNR is this correct?

If a patient is crashing you still get out the crash cart and start CPR is this right even if they have an advanced directive?

Is it the doctors responsibility to get the DNR order?

PS: Sorry to hear you have been ill lately. You are such a huge asset and add a wealth of knowledge to this wonderful website.

Daytonite, BSN, RN · Oct 21, 2007

Sorry. Yes. The doctor still has to actually write a DNR or No Code order on the chart. Legally, he/she is obligated to do so if the advanced directive indicates that the patient does not want to be kept alive by artificial life support and the patient is going south. For instance, I have discussed this with both my doctors (my internist and oncologist) as well as my sister who would become my healthcare power of attorney so they know what it is that I want done. Still, the doctor would have to actually write the DNR order on the chart. Without that DNR order the nursing staff must start CPR if the patient codes. Now, this applies to a patient who is hospitalized. All facilities will have policies in place for how DNRs and Code Blues are to be written. Next time you are in your clinicals check this out in the policy and procedure manual. There may be other laws that apply to patients who are in their homes or out in public places. The individual state laws would apply.