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Can a DNR order be a TO

Posted

Lets say you have a new admit who requests to be a DNR, can the MD order the DNR over the phone without first assessing the pt or does he have to physically sign the DNR form before it becomes active?

chenoaspirit, ASN, RN

Specializes in Med/Surg, Home Health.

I always had the MD come to the floor for that type of order. I never wanted to be held responsible if anything ever came up in the future. The MD would come to the floor and discuss options with the patient and then write the order.

I dont know if its acceptable to take the order by phone, I just never would do it. Check your facility policies book.

It's a DNR order.GOD forbid, but is something should happen at the point in time

it is not reversible. I think an MD would need to make very certain of that decision.

Plus you also need patient's signatures. It's not just the MD's call to make.

And if all that has been done and he only wants to have a formal order then please

have another nurse on the phone as a witness. Do tell the MD of course.

Lets say you have a new admit who requests to be a DNR, can the MD order the DNR over the phone without first assessing the pt or does he have to physically sign the DNR form before it becomes active?

The thing of it is, what does DNR mean to the patient? You have to be sure that what the pt actually wants-- does that mean no chest compressions, but you can give vasopressors and fluids? Does he/she want a central line? Does he want to be intubated? I would think that this type of thing requires a face to face conversation with the covering doctor.

Check your facilities policy. I work in acute care. We can take DNR orders over the phone, another RN also has to take the order, and it is signed by both RNs. The order must be cosigned by the MD within 12 hrs or it is no longer valid. This usually occurs when the pt has been a DNR on previous admissions, or after the physician has had discussions with the patient and/or family, MPOA and they had to "think it over."

It's a DNR order.GOD forbid, but is something should happen at the point in time

it is not reversible. I think an MD would need to make very certain of that decision.

Plus you also need patient's signatures. It's not just the MD's call to make.

And if all that has been done and he only wants to have a formal order then please

have another nurse on the phone as a witness. Do tell the MD of course.

A) A DNR is not permanent and can be revoked at anytime.

B) Not all hospital policies require patient signatures to make them a DNR. All it takes is "Patient is a DNR" and MD signature on the order sheet.

BreeLPN2RN

Specializes in LTC, Med-Surg, GP Office. Has 30 years experience.

It's a DNR order.GOD forbid, but is something should happen at the point in time

it is not reversible.

I think what Katie5 meant was death resulting from DNR is not reversible.

RedhairedNurse, BSN, RN

Specializes in Med Surg, Ortho.

In order for a DNR to be accepted in our facility it has to be written in two separate areas of the chart:

1) The doctor has to write the order.

2) The doctor has to address the DNR in the progress notes.

loriangel14, RN

Specializes in Acute Care, Rehab, Palliative.

really? Where I work if the pt says they are a DNR then they are. The doc has nothing to do with it. It is part of our admission process. We ask the pt if they want to be a DNR and they say yes or no and it becomes part of the chart. I am a PN and I discuss this with pts what DNR means and the implications of being a full code. DNR is not an order signed by anyone, it's just in the computer and usually stated this on the paper chart somewhere as well.

We can take a DNR order over the phone at my facility, but you need a second nurse to witness it.

bill4745, RN

Specializes in ICU, ER. Has 15 years experience.

In our hospital it must be written by an MD. In some cases it is written by the house doc if the pt's doc is not available.

Each state and facility is different. It would be wise to check policy on that. Where I work a doctor has to talk with the patient or family, write the order, and address it in the progress notes before it is valid. If they haven't done these things before that pt. codes then we run a full code. They aren't very srtict @ the progress notes but they are firm on the other issues. Also each time that pt. is admitted a new DNR order is required...they do have the right to switch back and fourth if they are aware enough to make that decision.

FLArn

Specializes in Hospice, LTC, Rehab, Home Health. Has 20 years experience.

As stated earlier, the guidelines vary from state to state. In the setting I work, once the patient or POA signs the DNR form it is in force the MD signs the form within 24 hrs. (I am in an inpatient hospice unit, so the docs are in everyday.

nerdtonurse?, BSN, RN

Specializes in ICU, Telemetry.

At our shop, we can get a verbal if the pt's from a nursing home, well known to the doc, and they forgot the form. Most of our frequent flyers, we know their status -- but we still have to have the form/order, every time. For a couple, we treat as Full Code regardless simply because the family changes their mind every 5 minutes, and we all know what's coming -- one poor thing, she started going down and the son ran in screaming, "DO EVERYTHING, I CHANGED MY MIND." Now her chart says she is specifically to be a full code without a signed DNR by the doc AND all 8 kids. Poor thing, it's not because they love her or will miss her -- they all live in her house, and several have wanted to know how long before we have to tell the state she died...the doc called adult protective, but there's no law against being a leech, apparently...

If the pt tells me they want to be a DNR, the doc has to write the order, especially if they are in for something simple like a lap chole and have no other health issues. The last thing I want to do is be a method of suicide for a depressed person -- death by nurse as opposed to "death by cop."

And I've also called our house shrink up to have him sign off on a person being legally capable of giving consent to the DNR. I hate futile care, but I don't want to get into one of those situations like happened in England where the person got the DNR then overdosed on something deliberately.

OldnurseRN

Specializes in ED, Med-Surg, Psych, Oncology, Hospice. Has 30 years experience.

We, too get family members who want everything done though Momma or Daddy expressed wishes to the contrary. I hope my family never loves me that much. To ensure that, I have a friend, who WILL NOT give in to the pleadings of my grief-stricken children, and will ensure MY wishes are followed. She IS my Durible Power of Attorney for Health Care and she does know precisely what I want.