DNR orders

Specialties Geriatric

Published

Do you know the DNR/full code status on all your residents off the top of your heads? Seriously. Forget the bracelets or other ways that indicate a DNR. (except the doc's order) You may think he/she is, but aren't quite sure. Our supervisor says all nurses should know the code status of each pt. :chuckle In an emergency? :rotfl:................:stone

I'll be quite honest that out of 60 residents there are maybe 10 I can say right off the top of my head that I 100% know are DNR. BUT, is the order expired? :uhoh21: I'm supposed to know this off the top of my head because running to the chart/computer is a waste of time in an emergency. Say the order wasn't renewed, pt expires. Now he's a full code. :uhoh3: Pt/family doesn't want a full code. :angryfire So if a pt has a DNR order, why does it have to expire? He should either be a DNR or not unless, of course, the pt/family changes their mind. :smackingf :selfbonk: :bugeyes:

Specializes in Critical Care, Pediatrics, Geriatrics.
CPR is resuscitation, hence the name Cardiopulmonary resuscitation.

that goes without saying

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What about other LTC facilities? Do you have a DNR order that expires after so many days and needs renewal? Or do you have one DNR order that is reviewed at the team (care plan) meeting but never needs renewal?

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Specializes in Utilization Management.
What about other LTC facilities? Do you have a DNR order that expires after so many days and needs renewal? Or do you have one DNR order that is reviewed at the team (care plan) meeting but never needs renewal?

That really should be illegal. There are lots of people who draw up DNR orders and then they lose the ability to keep mentally alert enough to participate q 90 days to draw up other DNR forms.

It makes me feel that a lot of hospitals and LTCs really are following the wishes of the family, and not the patient.

Which is morally wrong, but they do it because after all, when the patient is gone, it'd be the family that sues the facility.

Earlier, someone brought up the issue of EMTs. Frankly, if someone has a DNR on their person, and another person knows about it, and the person expires--why call the EMTs in the first place?

I would have to assume that their thinking is that they were called in order to resuscitate. In our area, we have to have the DNR signed by the patient and the MD, so if the paper isn't exactly right, the EMTs have to resuscitate.

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Specializes in Gerontology, Med surg, Home Health.

Our DNR orders here in Massachusetts do not expire. The only way they change is if the patient or the family member(IF they are the Health Care Proxy) changes it. We also have a form called the Comfort Care Form...basically a DNR for life. The form stays in the patient's chart until they go home.There are several detachable "bracelets" on the form. If they have to go to the hospital for anything..stitches, xray, whatever, we detach one of the bracelets, stick it on the patient's wrist and send them out. It's the only way the EMT's know the code status. If the person doesn't have a bracelet or the original comfort care form, the EMT's are legally obligated to start CPR.

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Specializes in ER.
Earlier, someone brought up the issue of EMTs. Frankly, if someone has a DNR on their person, and another person knows about it, and the person expires--why call the EMTs in the first place?

I would have to assume that their thinking is that they were called in order to resuscitate. In our area, we have to have the DNR signed by the patient and the MD, so if the paper isn't exactly right, the EMTs have to resuscitate.

Where I live, 911 calls go to the same place, which automatically dispatches whatever needed - police, fire, rescue. Rescue is automatically dispatched for anything even remotely medical. And to report someone's death, you call 911. EMS brings in 99% of the people who die to our morgue. Sometimes I think the pts from LTC facilities go straight to the funeral home, because the LTC MD has already pronounced them.

But EMTs should not be resuscitating anyone with a DNR. Period. We had EMS bring a pt. in the other day c/o diff. breathing, who had a DNR. Sats were decreased, pt. was barely holding on - had she not had the DNR, EMS would have intubated her pre-hospital. But b/c of her DNR, they had her on a non rebreather. She died at triage. And no one touched her, because of the DNR. EMTs do not resuscitate as long as they see a signed DNR.

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To the OP....is that a state thing or facility thing.

In PA DNRs do not have an expiration date. Every quarter iit is reviewed at care conference.

As far as remembering everyones code status....BS. The facility is obligated to come up with a better system. Does the housekeeper or dietary staff have to remember everyones code status? I'll bet no. However they should be able to read a wrist band or an identifying marker on their name plate.

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It's a facility thing and I agree, the whole system needs to be changed.

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Specializes in Gerontology, Med surg, Home Health.

I'm perplexed...why would you call 911 to report a death? Don't you have RN pronouncements in your state?

We call the doctor, get an order to do the RN pronouncement, get an order to release the body, call the funeral home and they come pick the body up. Of course we call the family...I can remember though when the doc had to be the one to tell the family the bad news. Now they have the nurses do it.

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I can remember though when the doc had to be the one to tell the family the bad news. Now they have the nurses do it.

Our docs still do it, thank God.

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Specializes in Gerontology, Med surg, Home Health.

I'd rather be the one to tell the family. Usually we have developed some sort of relationship with them...especially if their family member is very ill and they spend a lot of time in the center. We know them...they feel comfortable with us. Many times they hardly know who the doc is. Most of our patients don't have their PCPs take care of them once they get admitted. Most of the PCPs don't come here. And let's face it....most nurses have more compassion than most docs.

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At my facility, the DNR's to not expire. In fact, if a res signs their own LTP for I.V. fluids, tubes or whatever, then it can not be changed, even if another family member has POA. If the POA is who initially signed, then they can change it, or if the res isn't incompetent by the care plan, than they can change it.

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I work in a LTC facility in MA and DNR orders do not expire. I'm also confused as to why you would call 911 to report a death?!

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