DNR

I don't have a current textbook that I can look up, but in practice (that I've seen) they are renewed once per admission. That is, if they have DNR/DNI in their advance directive, the admitting provider orders their code status as such. Family decides to make them DNR/DNI when it's clear prognosis is poor, the provider orders it. They are brought in unidentified, they are assumed to be full code until they wake up and say "I'm a DNR," then the provider orders the change to their code status. You get the picture; it's not re-ordered every day.

Now in the community or LTC settings, I'm not sure how often they're reviewed. For sure not daily, though!

Keep in mind that DNR doesn't mean "do not treat." If someone is having an MI and is A&O and can consent to medical or surgical management, then yes they would treat it. Of course if the pt says they don't want intervention, then they'd do comfort care only. If they have a full arrest and the pt is DNR/DNI, then they would of course honor the DNR/DNI. Also some people are DNR but not DNI. So if they get pneumonia or some other pulmonary illness, are expected to recover, but need to be put on a ventilator then they do intubate.

DNR means "do not resuscitate." It does not mean, "Don't give any care." However, that said, there are nuances all over the place.

Some places have forms that allow the patient/decisionmaker to specify what interventions might be acceptable, and what not. For example, "chemical code only," meaning give drugs but no CPR and no intubation. Or CPR, but no intubation. Or comfort care only, no matter what (this might be what could happen with an expected terminal event like an MI).

I don't know about any rules about how often a DNR has to be "renewed," but it can be revoked by the person who's responsible at any time. In the field, people can have bracelets with DNR on them tied to a numbered form issued on a physician prescription by the department of health. Their forms are tacked up in their kitchens on their fridges, and they wear the bracelets so nobody will give them unwanted interventions if they go down at the MallWart or someplace. Anyone who changes his mind just removes the bracelet and discards the form.

The idea that your health care proxy can change your DNR means that you had better be good and sure s/he won't, if that's what you want when you are in extremis.

Most of the time, I believe re-ordering a DNR goes according to facility policy. For example, at my facility, a MOLST form specifying DNR/DNI order needs to be renewed every 72 hours while the patient is admitted and at each subsequent admission.

nynursery has a good point. The facility policies are probably based on state rules. These may vary between states.

Wow, thanks for the responses guys. So it varies widely. On the Q&A's I've answered... the rationale gave yearly... but on the review book, it was either daily or 90 days. Thus, I was confused. But it depends on the policies, I guess. That's interesting.