Should I be Concerned?

[dbrowneyes712]

I am the night LPN supervisor at an newly opened Assisted Living Facility. It was explained to me in orientation that if a resident is found unresponsive no v/s and has a DNR on their chart that we are still responsible to call 911 and initiate CPR. Should I be concerned? And when asked could I have this in writing from the State of New York I seem to be getting the run around for months. Please someone out there help? What should I do? It just does not sit right with me. And I seem to be the only one concerned. I thought DNR meant just that.

[oregon-rn]

You should be able to access your ALF rules & regs on the web. If it is in black & white it is the best way to back your self and patient wishes. How about any family? Maybe you can confirm with the physician, family, resident and chart, chart, chart. Also you should have an Ombudsman and a Senior Services available to assist your dilemma. Doctor orders and resident wishes and your state laws are above facility rules.

[GAstudent]

I would be worried too..To me DNR means DNR...it makes me so sad to see it, but everyone is going to die sometime.

[healingtouchRN]

DNR doesn't mean don't assess, provide care, nuturing, vital signs, treatment for fevers, infection, nutrition, hydration, clearing secretions, etc....In my dept we can even deliniate chemical code only, without CPR & intubation, people have so many options. Some families are fearful of DNR's because they think we will just let their loved one go uncared for...how scary?!

[noodlefrax]

I am new this this BB, so hello.

I am only a CNA, but as far as I have always understood, if they are a DNR, you are violating their resident rights as a DNR if you initiate CPR. If they seem as if they are crashing and their wishes were designated to DNR (or the POA designated DNR), just continue with comfort care.. ? This is what has been done for DNRs where I have worked.

[doobiedo, RN]

Originally posted by healingtouchRN

DNR doesn't mean don't assess, provide care, nuturing, vital signs, treatment for fevers, infection, nutrition, hydration, clearing secretions, etc....In my dept we can even deliniate chemical code only, without CPR & intubation, people have so many options. Some families are fearful of DNR's because they think we will just let their loved one go uncared for...how scary?!

I agree...but I also have seen where doctors are very scarce with what exactly it means to be DNR when they explain to pts and family. Some families interpreted things differently. Some thought it mean't do everything except CPR others thought it mean't don't treat at all. The doctor would leave and the family would discuss among themselves and if I was present I was usually very shocked at the differing opinions of the family members present and how they interpreted things. Yet everyone shook their head "yes" that they understood and few asked questions. I usually had to do alot of explaining and clearing misconceptions up.

I have also worked with many doctors to whom DNR mean't different things also.

It was usually a very gray area for me depending on what facility I worked at. I usually would try to get the doctor to write specific orders ie no CPR, No intubation, may use chemicals, etc...

Living wills don't always clear things up either..

[renerian, BSN, RN]

We have in Ohio DNRCC and DNRCCA. One will allow you to do some things but not the invasive things. Does your state have this?

renerian

[Todd SPN]

As a NAC and as a LPN also I have been told, CPR must be performed. The reason is we are not qualified to make judgement on whether someone in distress meets the elements of a DNR document. I don't know about RNs or paramedics, but it seems to me that paramedics have to talk with a doctor before stopping CPR.

And I should add, I was told if the paramedics come and we are not performing CPR and they report it, we lose our license.