Copies of a DNR from a different facility/hospital?

[gentlegiver, ASN, LPN, RN]

I sent a patient out to the hospital believing this person was a Full Code. I then called the On-Call who informed me this patient was a DNR/CMO. I did not find a DNR or CMO form in the chart (neither did the Nurse 's before me). At shift change, another Nurse found a copy of a DNR form in the chart (not in the area where it belonged). My question is this... Is a copy of a DNR from a different facility/hospital valid?? I was always told I had to have the original for it to be valid?

[happy2learn]

I would think it would at least have to be notarized.

[Asystole RN]

What State are you in? Each State has different laws concerning this.

In general you are safe if you are acting in good faith and act upon information you believe is correct.

Remember though that you are the patient's advocate, do you believe your pt was better served sending her to the hospital? Do you believe you followed the patient's wishes?

[Asystole RN]

I would think it would at least have to be notarized.

Most States this is not true.

[happy2learn]

Most States this is not true.

Good to know, thank you.

[CNL2B]

My facility accepts DNRs from home or from an outside facility if turned into medical records by the patient or surrogate. It then gets scanned in and becomes part of our medical record as well. MD has the responsibility on admission to verify code status. This is in the state of MN.

[prinsessa]

At our facility copies of DNRs are not valid. It has the be the original!

[tyvin, BSN, RN]

Everyone take a lesson from this and institute procedure that insures code status is known. Anywhere I've worked I have implemented a feature on the report that all RN's hand to each other at report time that shows the type of code. Or if it's not a paper report have a list of current patients up at the nurses station so that at a glance one can see what code status a client is.

At report ask what the code status is; seriously this stuff should be known. This is not the time to be scrambling at the last minute discussing political is it valid theory.

Of course this should also be on the outside of the chart (along with the allergies). Too often a code is called and everyone is rushing to find out what kind of code the person is. Bad form and unnecessary if you got it together.

And I do mean you. Don't play the it's not what we do or It's not my job. Client safety is key and this is probably one of the more important things that should be known.

If there is no code status implement steps and follow up but in the interim find out from the doc what the code status should be after talking to the client of course.

[ktwlpn, LPN]

I sent a patient out to the hospital believing this person was a Full Code. I then called the On-Call who informed me this patient was a DNR/CMO. I did not find a DNR or CMO form in the chart (neither did the Nurse 's before me). At shift change, another Nurse found a copy of a DNR form in the chart (not in the area where it belonged). My question is this... Is a copy of a DNR from a different facility/hospital valid?? I was always told I had to have the original for it to be valid?

But remember -DNR does not mean do not treat. You did not err in sending the resident out.

[CNL2B]

But remember -DNR does not mean do not treat. You did not err in sending the resident out.

CMO (comfort measures only), however, generally means do not treat.

[ktwlpn, LPN]

CMO (comfort measures only), however, generally means do not treat.

Yes but DNR and comfort measures are not interchangeable terms-that's what I meant. We have had this discussion in our LTC for years-many nurses think if we have a comfort measure resident or hosipce care resident we don't do anything for them...Not so...We treat their symptoms and we have sent them out if we could not get their symptoms controlled.We have also been dinged by the DOH for writing "do not hospitilize" orders...I recently had a 94 yr old hospice resident fall and break her hip.She survived surgery and was doing pretty well for a time-then had a cva,went to the er for eval of that and then came back the same day-lived 8 days

[tyvin, BSN, RN]

DNR means do not resuscitate and has specifications such as antibiotics, g-tubes ect...

If a DNR is experiencing complications oxygen and suctioning are most often allowed. These are comfort measures and should be included in the DNR. Or if they fall and break something then most certainly they must be sent out but to keep in mind no cpr rule and whatever else the DNR dictates.

If someone makes a mistake in LTC and calls 911 for a DNR it is too late when the EMT's arrive because they have a duty to serve the call as a full code.

This actually happened at a LTC place in Hawaii I worked at and when 911 came through the door I was so shocked. The charge did not know the client was a DNR and the EMT's took her anyway even though I tried to clarify but it was too late. That poor women ended up on a feeding tube and lived another 6 months. It was truly sad.

It is our experiences in nursing that can make us better at what nurses do. This is why I'm such a stickler when it comes to codes and knowing exactly who is what. That women should have never been resuscitated.