Can a DNR order be a TO

[Bug Out]

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?

[FLArn]

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]

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]

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.