Dnr/dni?

[neurorn6]

Here is my question, why does the DNR status differ so much from region to region. This is why I ask. When I worked in South Jersey, about 6-7 years ago, we were informed that "Med Only Codes" were not a legal order. We were also told that "DNI" was not legal either. The reason being that if you don't do chest compressions then meds were useless. In a nutshell, you wrote DNR period if the patient did not want heroic measures. Also, why is it that in certain areas Advance Directives are not discussed with or explained to patients and their families.

It drives me crazy! Not only with physicans but with some nurses that I have worked with. I was taught and trained that we have to be patient advocates. That it is our job to provide the patient and their family with all the information even if we are uncomfortable with it. If my personal belief's conflict with what I need to do, then I find a coworker to help me do what needs to be done for my patient. A few years ago, Joint Commisssion did a push on Advance Directives but here it's like the least said about it the better. Any thoughts on the subject?

[BBFRN, BSN, PhD]

Re: nurses being responsible for Advanced Directives, some of this issue may be dependent on which hospital you work for, and what their general patient population consists of. When I worked at a level 1 trauma center, we were primarily responsible for going over AD with the patients, because most of the patients were there after an unplanned event. In another hospital, we didn't do it as often (we did check all patients to make sure it was done, and did it ourselves, if not), because most of their patients were in the hospital after a planned surgery. So, this was usually done beforehand (either in the physician's office, by the admissions staff, or pre-operatively.

I think I remember there being a big lawsuit here about 10 years ago (maybe someone else knows the specifics) regarding a patient's right to have a DNI. I agree with you on that- too many loopholes there in a real code. Re: meds only codes- I agree with you 100%, and know most nurses and physicians in the area would, too. I'm not sure why they allow that, but I have spent time explaining what that actually meant to patients before, and had them change their minds.

[neurorn6]

At some point I believe that there has to be a standard that truly governs the rules for DNR. As a patient advocate, nurses must be on the front lines in providing factual information to patients and their families. It only makes our jobs that much harder when patients don't have all the facts. At least that is my humble opinion.