DNR Consent Form??

[bonesrn]

Ok...here's one for ya'll...in the past week we have had 2 incidents involving patients who were coded but had a DNR order...the problem lies in the paperwork..the facility policy states that when the MD writes the DNR order that the MD or the nurse will obtain informed consent. Currently we have docs writing the order on your standard order sheet..we also have a pre-printed DNR order sheet where the doc checks the box "DNR" or "resusitate" then we have the informed consent... some of the nurses (per DON clarification) see the written order, give the patient the blue arm band and place DNR sticker in chart even though the informend consent has not been signed because they feel that once the doc writes the order we must follow it..others don't do anything with the order until the informed consent is signed? I have never heard of informed consent for a DNR in any hospital I worked at..it was understood that if the doc is talking to the family and writing the order that consent was obtained.

So today I went thru all the charts and found 2 residents who have a written DNR order but no informed consent. One order was written back on Jan 18, one just a few days ago but because the consent form is not signed they are still full codes...so if they code before we get family to sign consent we must proceed with the code even though the doc has already spoken to the family but no mention is made of this extra step????? I have images of Mr. X wife, who spoke with the doc and agreed to the DNR, coming in while we are coding her husband because we forgot to get the consent sheet signed?

If we are going to use it fine but I can see the communication being lost in the shuffle..what if I'm the POA and I live 3 states away but I speak with the doc and tell him yes I want dad to be a DNR but then am told I need to physically come in and sign the paperwork and unless I sign the consent we have to keep him a full code???

It just seems like we are setting ourselves up for bad things. To me if we have the written DNR order then that is what we follow, with or without the consent. Yes, the consent is a nice CYA piece of paper for the facility but it is not really necessary leaglly?

Just wanted to get some other perspectives and to see if any other facilities are using this same practice.

Thanks

[McGyverRN]

I agree with you. If a pt has a DNR order, that should be enough. What is your facility's policy of a DNR consent obtained from a family member over the phone in an acute change in condition?(assuming the pt is unable to speak for him/herself) Do they expect you to code the patient regardless? In my facility a DNR order is all we need. If the MD is giving a DNR order over the phone, 2 RN's must take the order as verification. Your facility may be using the informed consent as a CYA move, but it may backfire on them. If it is not a law in your state but the policy is that you resusitate when informed consent is not signed, and a family has already given verbal consent for DNR, I think the family would have grounds for a lawsuit.

[lsyorke, RN]

A doctors order for DNR is written after he speaks with the family or see's the advance directive. It's his responsibility to document this in the progress notes. Getting another informed consent is redundant and not necessary.

[bonesrn]

Thanks for the backup...they just don't get it! I told the DON that if I have a DNR order without consent then I am not going to code the patient, ( that's what a reasonably prudent nurse would do) if they want to write me up for not following policy and procedure then so be it. I have talked with other RN's at one of the local hospitals and she said the hospital/RN etc could actually be sued for assault and battery by performing CPR on a patient who clearly stated that they wanted to be a DNR! The Risk Manager feels that one would never get into trouble for performing CPR regardless but we could be in trouble for not performing it? I asked the DON if the RM had consulted legal but she said no. I think I may go to legal myself. Thanks for all your input...I love this forum!:)

[jmgrn65, RN]

A doctors order for DNR is written after he speaks with the family or see's the advance directive. It's his responsibility to document this in the progress notes. Getting another informed consent is redundant and not necessary.

Our Facility does the same thing as the above op. I have never heard of informed consent for DNR. My suggestion for you is to become proactive and do research on this, just do a google or dog pile search and present it to your DON. Good luck

[CoffeeRTC, BSN, RN]

This is acute or LTC?

On admission we have our admissions coordinator review the CPR consent forms, they will go over what is CPR,etc. The family or resident will sign this. We also do over the phone consent with two staff witnesses and will send them a form to sign and mail back or fax. Of course we will add the yea or nay to the orders. Rarely does a doc talk to the family to get the consent, mostly because we would wait a week plus for a doc to see the pts in LTC

[thumperRN]

When a pt arrives at our hospital, we determine if they have a living will or not. If they don't, a care manager comes and speaks to them about obtaining one and also about code status. At that point, when the Doc comes, he is notified that the pt or family wants DNR or Full Code. The order is then written by the Doc and then followed by the staff. Never heard of informed consent for a DNR, sounds like that could cause confusion. We are already drowning in a sea of paperwork. If the patient is A/O and wants DNR, than it is up to us to respect that.

[bonesrn]

I actually did some online research and found documented cases of docs/rn/hospitals being sued for assault/battery, pain and suffering, negligence, and a whole bunch of other charges r/t the problems the patients suffered because they were coded when they had a DNR order in place, cases involved codes on the unit and in OR, Radiology etc) The policy needs to be changed. The law doesn't require informed consent as that is implied when the doc writes the order ( I was told this by attorney) so they are just setting themselves up for problems. Most of the nurses are in agreement that if we see an order written that it is enough and we won't code the patient. Of course getting anything changed is an act of congress since it has to go thru 10 different commitees so I don't see it happening anytime soon. I just hate it when the bean counters are the ones making the rules when they are not out there doing the work. If God forbid someone actually did code a pt with a DNR without the consent form being signed the risk manager isn't the one who will lose her license. We even asked the docs today and they all said if I write the order that is enough. I am torn between going to legal myself since I have already been to DON and risk manager. Thanks for all the input!