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Discussion

Difference between "no code" and "DNR" concepts

Hello:

Can someone explain the difference between the ideas/concepts of "no code" and DNR.

As i understand it from reading so far, no code means that the physician makes the decision to code the patient. DNR is a directive that the patient or family/surrogate agrees and signs regarding life saving measures.

What do you think?

thanks

rj

Featured Replies

No, they're the same thing.

Hello:

Can someone explain the difference between the ideas/concepts of "no code" and DNR.

As i understand it from reading so far, no code means that the physician makes the decision to code the patient. DNR is a directive that the patient or family/surrogate agrees and signs regarding life saving measures.

What do you think?

thanks

rj

no-just 2 different terms for the same thing.An advance directive or living will is a form the patient (or their guardian/poa) has completed which directs the course of their treatment should they be incapacitated to the point that they can't speak for themselves. They are not legally binding and very open to interpretation .Google the forms and you'll see many templates. They are sort of like an ala carte menu and many people request every intervention known to man so an advance directive is NOT always a dnr/no code.
  • Experts

They are both the same order, just written two different ways. The order means you are not to do any resuscitation (assisted breathing or chest compressions) of the patient to keep them alive if they have become apneic or asystolic.

Most hospitals have a "code" system in place. Code Blue is the common designation for all out resuscitation of a patient when they have stopped breathing or their heart has stopped beating. You'll hear it announced over their speaker system, "Code Blue, room xxx." Usually 3 times. One hospital I worked in used the term "Express Team" rather than "Code Blue". It still meant the same thing. Many hospitals have also developed policies regarding how a "no code" or "DNR" (no not resuscitate) order are to be written as well to avoid any confusion. There are some places that use a designation of "chemical code" where only life saving drugs are administered and no chest compressions or assisted breathing are done. The patient's fate lies in their response to the drugs.

I think another concept you might be alluding to is the advanced directive and living will where the patient is legally allowed to make the decision about whether or not they want to be resuscitated. These are determined by state laws. You would have to see what your specific state law is in regard to this. In many states, if a patient has a living will, which is a legal document, that states they do not want to be resuscitated, the physicians must comply with the patient's wishes. I know that my local hospital has my advanced directive in my chart and I don't even need to bring a copy of it with me when I am admitted anymore. They just pull a copy out of my medical record and pull it forward into my current chart. By federal law all hospitals must inquire of all patients if they have an advanced directive or living will upon admission.

  • Author

wow, excellent information. thank you for the quick response.

Have a super most excellent weekend.

rj

But now both those terms are outdated. We learned "AND", Allow Natural Death.

Geez, can't we just keep something the same!??

Pat

But now both those terms are outdated. We learned "AND", Allow Natural Death.

Geez, can't we just keep something the same!??

Pat

It can be annoying when there seems to be so much change just for the sake of changing things. This, however, could be an important restatement of a goal.

"Do not resuscitate" and "no code" both put the emphasis on withholding life-saving measures. Stated that way, it seems as if the patient is being deprived in some way.

Saying "allow natural death" instead makes room for the idea that forcing drastic (and often painful) measures on a body that is ready to go can be more of a deprivation than doing the heroics. It acknowledges that a peaceful death (as opposed to a violent resuscutation effort that may well end in failure) can be seen as a valuable transition and ought not to be taken from the patient against his or her will.

DNR asks practitioners to resist doing something they are conditioned to want to do. "Allow natural death" permits them to see a graceful transition as one final thing they can do for the patient. They can then view their part in the last moments as giving rather than withholding. This can make a big difference in the caregivers' willingness to respect the patient's wishes and in their response to the passing itself.

It's the difference between saying, "Don't do something bad," and saying, "Do this good thing that the patient has chosen," and that can be huge.

  • Experts

The fact is that all acute hospital facilities will have a policy about how do not resuscitate orders are to be written by the doctors. This policy is usually explained and stressed with all new nursing employees. Nurses who work on units where these kind of orders are often written know this policy and if a doctor does not follow it will bring it to the doctor's attention or the attention of their nursing manager or supervisor. It's very easy to find the policy in a facility's policy manual.

Also depends on what state you live in. In Ohio where I am at, DNR is broken down into DNR-CC (comfort care) or DNR-CCA (comfort care arrest). In simpler terms, DNR-CC means that we do no life saving measures, but can provide O2, turn q 2, suction, oral care, etc for their comfort. DNR-CCA means that we can do anything up until the time that they code. In other words it includes everything from DNR-CC, but also intubation, perform "chemical codes" until they code, emergency central lines, and cardiac telemetry (not done on DNR-CC).

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