DNR pet peeve

Long Term Care Columnist / Guide · Jan 28, 2012

I see this happen all the time with my assisted living residents. They fall and crack their heads open, scalp open to the skull, they're altered....and when the paramedics arrive they look at the POLST form and go "Oh, s/he's a DNR, we're not going to transport." Excuse me, since when did Do Not Resuscitate become Do Not Treat?

I've fought this battle many times over, and I usually win even though the resident almost always gets boomeranged back to me within hours. Frankly, I don't care if they have a DNR---so do I, and what that means is I don't want to be brought back if I am clearly deceased....if there are no vital signs and no respirations. If I'm alive, even barely, then for gosh sake take care of me! Who is an EMT, or a nurse, to make the decision not to treat something that may be fixable?

Most DNRs have subsets of orders that provide for the patient's wishes as to whether s/he wants short- or long-term artificial nutrition, antibiotics for infections, IV fluids, etc. I've even advised a few EMTs to ignore those orders at their peril........I certainly won't be the one to answer charges of failure to rescue.

GitanoRN, BSN, MSN, RN · Jan 28, 2012

Unquestionably, DNR stands for Do Not Resuscitate. In other words, a person who does not wish to have cardiopulmonary resuscitation CPR performed may make this wish known through a doctor's order called a DNR order. Therefore, a DNR order addresses the various methods used to revive people whose hearts have stopped functioning or who have stopped breathing. Following this further, several examples of these treatments include chest compressions, electric heart shock, artificial breathing tubes, and special drugs. On the other hand, the goal of palliative care is to relieve suffering and provide the best possible quality of life for people facing the pain, including symptoms and stresses of serious illness. Moreover, it is appropriate at any age and at any stage of an illness, and it can be provided along with treatments that are meant to cure. In order to get palliative care, you must ask your doctor for a referral. Lastly, if a person is interested in Palliative Care, they need to do a little research at hospitals in their area that offer palliative care. In conclusion, it’s understandable that not all medical staff is aware of the differences between these two. However, is imperative that every medical staff should be aware and understand the differences, in order to offer some information to their patients regarding the two treatments.

MN-Nurse, ASN, RN · Jan 28, 2012

I'm thankful my facility does a pretty good job with this. Just today I had a 94 year old DNR pt who was starting to tank on me. The on call doc did not withhold any care or appear disinterested in treating this pt due to DNR status.

sapphire18 · Jan 28, 2012

This is a huge problem I have with some nurses/doctors, as well. DNR DOES NOT MEAN DO NOT TREAT, PEOPLE!! It is scary and unsafe and it is not acceptable for health care professionals to not know the difference. If patients/families want less done in the event of illness (no feeding tube, abx, etc etc) other than just a DNR then they need to specify that in a living will!!

dudette10, MSN, RN · Jan 28, 2012

Therefore, a DNR order addresses the various methods used to revive people whose hearts have stopped functioning or who have stopped breathing. Following this further, several examples of these treatments include chest compressions, electric heart shock, artificial breathing tubes, and special drugs.

Maybe it depends on the facility. At my facility, DNR means do not do chest compressions and do not breath for the patient (any method) if the patient's heart and breathing have stopped. Electrical cardioversion, intubation (if the patient hasn't stopped breathing on his/her own all together), and special drugs are considered pre-arrest emergency interventions, and they can be done on a DNR patient. It is apparent that the OP's facility also sees cardioversion via drugs or electrical shock as a pre-arrest intervention on a DNR patient too.

CapeCodMermaid, RN · Jan 28, 2012

DNR--we do not initiate chest compressions or rescue breathing. We also have Do Not Intubate, Do Not Hospitalize(except for fall with fracture), No IV, No GTube.It's no wonder so many people and families won't sign a DNR since they think it means we are going to do nothing if they get sick.

**NickiLaughs, ADN, BSN, RN** · Jan 28, 2012

i'm more irritated when the family wants us to do everything and the patient is in their 90's. They seem shocked that a 90 something year old might be ready to go to heaven.

CapeCodMermaid, RN · Jan 28, 2012

Obituary common on Cape Cod: Died unexpectedly at the age of 98.

If you don't expect to die when you're 98, when DO you expect it?

However, people are entitled to choose whatever extreme measures they want at the end of life.

Vespertinas · Jan 28, 2012

Sometimes they don't understand what's fixable and what's not. In my case, I had to explain to my patient's daughter that if her 93 year old mother throws another PE and we intubate, it won't end well. But I had to earn her trust by explaining that there are other things that may come up in her medical care which we CAN fight to fix and that DNI meant only that we wouldn't begin artificial ventilation. It took a lot out of the daughter to agree to a DNR/DNI and I want to follow through on her wishes.

I'm not irritated that she wants to keep her mom alive. I also to see her mother be discharged from the hopsital because it's entirely possible. Daughter wasn't ready for her mom to pass away and I can sympathize with that. I also have no right to say that her mother should die today versus in a year or two in a nursing home or at home with family.

Not_A_Hat_Person, RN · Jan 28, 2012

Unfortunately, I've had to deal with this twice in the last few months. When my mother was diagnosed with cancer, she wrote her wishes down; it wasn't legally binding because her state didn't recognize living wills. Years later, when she was admitted to the nursing home where she eventually died, I was her health care proxy. I made her DNR and DNI, but they really, really pushed for Do Not Hospitalize. She was on hospice, but I still wanted her treated if she broke a limb.

My father, in another state, was a DNR when he coded, but the unit ran the code anyway. He ended up intubated on a vent, which is definitely not what he wanted. We took him off of life support 4 days later.

When I worked in assisted living, one of the admissions questions asked about advance directives. Some people panicked, thinking we wanted a signed DNR for admission. We were more interested in whether they had a DNR, a Health Care Proxy (or Health Care POA), or both.

Vespertinas · Jan 28, 2012

My father, in another state, was a DNR when he coded, but the unit ran the code anyway.

How is that possible??

When I worked in assisted living, one of the admissions questions asked about advance directives.

I'm not sure if it's a JCAHO requirement, but every hospital I've worked in has this question in the admission database. That doesn't mean we necessarily ask it...

In better hospitals, every family on admission is GIVEN a packet with advance directive forms. Then it's up to the family whether they want to fill it out