What does DNR mean for the caregiver?

[IHeartPeds87]

Hi everyone. Sorry to bother you. So I work home health, and was recently told that my client has a DNR status. As an uncertified caregiver, what does this mean to me? I was told "you don't call 911 unless it is an acute care situation" and that I should instead call client's family and then my boss, but I would like clarifications:

- So if I suspect a heart attack, do I call 911?

- If client is breathing very heavy do I call 911?

- If client is sweating profusely but is cold/clammy?

Basically, under what circumstances legally do I have to call 911? Like, if the client has a fall and breaks a bone or something then obviousely I would call but in not so obvious situations....? :confused::confused:

Sorry to bother you all, i'm just confused and would like clarifications.........talking with a friend of mine has gotten me confused

[Up2nogood RN, RN]

They can be DNR but still want interventions such as antibiotics, ivf's, O2, medical tx such as setting a broken bone.

DNR usually is no chest compressions or artificial airway but this can vary per the pt's advance directive. It would be good to find out your client's wishes and definitely ask your manager for tips on when to call EMT's.

[loriangel14, RN]

DNR means if they are DEAD you do not attempt resusitation. If they are still alive you still treat/get help. Do not resusitate does not mean Do Not Treat.

[JSlovex2]

the definition of resusciate: to revive, especially from apparent death or from unconsciousness.

unless they are dead or appear to be dead - you seek help. DNR means do not bring them BACK (revive) from death.

[casi, ASN, RN]

It means if their heart has stopped you don't bang on their chest. If they are still breathing and they don't have any advanced orders such as "do not hospitalize" you still get them immediate help if they need it.

DNR does not mean do not treat.

[merlee]

Are you saying that you are a paid caregiver, such as a home health aide? If so, you need to seek the answers to your questions from your agency.

Aside from the obvious, like a fall, the likelihood of a truly acute situation needing a 911 call is remote. But, again, I urge you to call your agency.

[akulahawkRN, ADN, RN, EMT-P]

Generally, DNR means no chest compressions, no ventilations, no cardiotonic drugs, no defibrillation, and no intubation. It does NOT mean do not treat. In short, if the patient needs CPR... let the patient go. You should have written instructions about who to notify when that happens. If the patient is ill, sick, injured, whatever, and is generally anything other than dead: take care of the patient. That may mean calling 911. For all those things listed, 911 is probably appropriate. To be certain, read the order. Also, understand that sometimes, the patient may be in their final stages of life and nothing can be done except comfort measures because the drugs normally used to support life can't be given. 911 may not be appropriate in those instances.

[Faeriewand, ASN, RN]

Great question with a lot of good answers already. Like other posters said, check with your agency. Also, ask if the patient is on hospice.

[brownbook]

This can be the most confusing misunderstood topic in health care. As a nurse it seems simple to understand, what I want for my patients, myself or family. As previous posters have mentioned, no compressions, etc.

Yet caregivers, family, get so confused, mixed messages, etc. A very elderly friend was in mild distress. The bright, young, but not "medical" caregiver asked me what to do, I suggested getting her under hospice care!!!! The care giver said, "oh no, I know you can't call 911 as soon as you are under hospice care....the family doesn't want that!" So this poor elderly lady gets rushed to the ER, intubated, etc. fortunately they did agree to remove the tube after 24 hours and she died shortly afterwords!

I keep visualizing a DNR hospice patient breaking a leg, 911 is called, the paramedics arrive and say "Uh oh, you are hospice DNR, we can't treat you, good-by!!!!!"

[akulahawkRN, ADN, RN, EMT-P]

This can be the most confusing misunderstood topic in health care. As a nurse it seems simple to understand, what I want for my patients, myself or family. As previous posters have mentioned, no compressions, etc.

Yet caregivers, family, get so confused, mixed messages, etc. A very elderly friend was in mild distress. The bright, young, but not "medical" caregiver asked me what to do, I suggested getting her under hospice care!!!! The care giver said, "oh no, I know you can't call 911 as soon as you are under hospice care....the family doesn't want that!" So this poor elderly lady gets rushed to the ER, intubated, etc. fortunately they did agree to remove the tube after 24 hours and she died shortly afterwords!

I keep visualizing a DNR hospice patient breaking a leg, 911 is called, the paramedics arrive and say "Uh oh, you are hospice DNR, we can't treat you, good-by!!!!!"

That DNR hospice patient that fell and now has a femoral neck fracture will still be treated by Paramedics. Why? DNR doesn't mean "Do Not Treat" to them either. Generally speaking, they'll still stabilize, start a line, and provide for pain control and transport. Remember, for quality of life, even if it's the final few months, that patient could still end up getting pins placed to stabilize the fracture and reduce pain. Hospice care does not mean that 911 is now suddenly contraindicated. Transport under lights/siren may be, depending upon local protocols/orders for EMS.

[tainted1972, ASN, RN]

All of the situations you described are good examples of acute illness, so yes you would call 911.

Acute simply means something that happens suddenly and that is new, as opposed to something chronic such as chronic kidney failure.

[IHeartPeds87]

Thank you!