DNR by Phone?

[Thornbird]

It has been my experience over many years and a lot of places, that a DNR order must be written on the chart by the doctor to be valid and legal. I have always been told that a verbal, phone or fax DNR order is not legal. I have even had to perform CPR on patients admitted on the weekend who were supposed to be DNR but didn't come with a signed DNR transfer and the doctor didn't come in right away to sign the orders.

I have recently been to a LTC that has a policy that telephone orders can be taken for DNR with two nurses listening on the phone and co-signing.

I am very uncomfortable about this. I always thought the reason that a doctor has to sign the initial DNR is that he is certifying that he explained to the patient/resp party what it means and obtained their informed consent for the order. What do you think? Are other people seeing this?

[racing-mom4, BSN, RN]

We take a DNR order by phone. In fact if 2 Rns witness family or pt state DNR we can write it and have Doc sign it the next day. We just document who was there and how it was said and that it was repeated and verified by pt/familiy.

[mama_d, BSN, RN]

We frequently take verbal orders for code status (regardless of full or comfort or anything in between) at my hospital.

If it's a situation where family is basically calling a stop to interventions that are going on, i.e., if we've got rapid response team in the room or are actually coding the patient, the intensivist writes the order so that we can stop immediately without waiting for a doc to call back.

[Tweety, BSN, RN]

Here telephone orders for DNR's are legal.

It would be cruel to have to wait until a doctor comes in if doing a code is against the patient and family wishes.

[NeosynephRN]

We can take a 2 RN phone order for a DNR as long as the physican comes and signs the order within 24 hours. Has saved us so many times!!!

[RoadwearyRN]

Have worked in several different facilities where verbal okay. Typically the issue is not so much with the physician order as the signed DNR by the patient or family. If patient is unable to sign or make known their wishes and or family not available for signature then 2 nurses must confirm their wishes and document in the medical record. The desired code status is then reported to the physician and the order obtained just like any other phone order.

[mandykal, ADN, RN]

whenever you doubt the policy, don't be afraid to question that way someone can explain it.

as long as it's within state regs., facility policy, and within your scope, you are safe! you can't go wrong or be liable.

[CapeCodMermaid, RN]

We can use a faxed order for DNR but never a verbal order.

[Havin' A Party!, ASN, RN]

Phone order is fine here in this LTC facility.

When I worked at the hospital, it was not.