DNR Orders

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I just started a new case(maybe a month ago).

Baby is 9 months old trach/vent/tpn.

Needs to be Ambubag a lot(maybe 2x a week)

Anyway,she has a DNR order. It says DNR to be followed at parent's discretion,meaning if her heart or breathing stops,and parents want us to do CPR,we must do it.

He(the nursing supervisor) says because its a child that parents can do whatever they want.

Has anyone heard of similiar situations?

Specializes in Pedi.
I guess I just don't understand the point of having a DNR if the parents can change their mind at any time.

An adult with a DNR can change his mind at any time too. There are very few things in this life that are irreversible. Why wouldn't a parent be able to change his/her mind? Parents can change their mind about many things for their child's care. They can sign consent to enroll their child in a clinical trial and then revoke said consent at a later date. They can agree to surgery and then decide the morning of they don't want to do it.

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My concern is not so much that they would change their minds about the DNR, but that they would misrepresent what really happened when bringing their lawsuit. The scent of money can change all kinds of circumstances.

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I had a patient that the order allowed all interventions but chest compressions. If they decided to change their mind and want them I would support their decision. I'd think you would face a higher chance of lawsuit if you did not follow through and the child died.

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Specializes in Peds(PICU, NICU float), PDN, ICU.

Get out if it isn't clear cut. Yes, they can change their mind at any time. But as things are happening its a bad time to change their mind. Our notes are only as good as our credibility in court. If a parent is unsure, its best to encourage them to make the child a full code since it can't be reversed if we follow DNR. I'd encourage the case manager to get the parents to go to some sort of counseling to help them make their decision and be confident in it. I don't know state specific laws other than my own. Safest option is to get out of the case.

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Get out if it isn't clear cut. Yes, they can change their mind at any time. But as things are happening its a bad time to change their mind. Our notes are only as good as our credibility in court. If a parent is unsure, its best to encourage them to make the child a full code since it can't be reversed if we follow DNR. I'd encourage the case manager to get the parents to go to some sort of counseling to help them make their decision and be confident in it. I don't know state specific laws other than my own. Safest option is to get out of the case.

Yes. I was esp thinking that if nobody is home and its an emergency,and I don't have time to call the parents,then what?

Of course,I would just save the child's life.

I do wonder what the penalty would be if I saved the kid and parents didn't want it if I was in a situation where I can't contact them.

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An adult with a DNR can change his mind at any time too. There are very few things in this life that are irreversible. Why wouldn't a parent be able to change his/her mind? Parents can change their mind about many things for their child's care. They can sign consent to enroll their child in a clinical trial and then revoke said consent at a later date. They can agree to surgery and then decide the morning of they don't want to do it.

I understand what you are saying,but during an emergency parents tend to be irrational.

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Specializes in Peds(PICU, NICU float), PDN, ICU.

This would be a great question for a nurse that works for a lawyer or is a lawyer. Just to be safe. The bad thing is laws can be interpreted differently by different people.

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