Healthy 22 y/o mom with DNR

Bill Levinson · Dec 3, 2004

Is a DNR order legal if the patient is not terminally ill? In Pennsylvania, a living will goes into effect only if the patient has less than six months to live, as I understand.

Burnt Out, ASN, RN · Dec 3, 2004

I've always understood that when a patient is pregnant and has a DNR, the DNR is suspended until after the birth of the baby.

Marie_LPN, RN, LPN, RN · Dec 3, 2004

I have DNR orders and i'm 27. If something would happen to go wrong, i do not want to wake up with brain damage, and bedridden.

I've run into this a couple of times last year, with 20 year olds with DNR orders.

kmchugh · Dec 3, 2004

Something to remember. All DNR orders are suspended when a patient goes to the OR. This holds true for the C-Section suite, as well. There are reasons for this, but the short version is we will not stand idly by while the patient dies from a minor reaction to anesthesia or surgery that could easily be rectified.

I have taken a number of DNR patients to the OR, and am always careful to explain to them that the DNR order will be suspended during surgery and the immediate post operative period, and why this is so. My guess is that the anesthetist explained this to your c-section patient as well.

In short: There ain't no DNR's in the OR.

Kevin McHugh, CRNA

Nurse Ratched, RN · Dec 3, 2004

In short: There ain't no DNR's in the OR.

Thanks, Kevin - I thought that was the case in my facility at least.

Side note: I'm always amazed at the lay person's misconceptions about living wills, POA's and health care rep status. (Heck, the professional's get confused about it.)

butterflynurse · Dec 3, 2004

My mother died of an aneurysm when I was only 6 days old. My dad told me they had on a vent, but she was braindead. He had to make to tough decision to take her off. She was only 35.

VickyRN, MSN, DNP, RN · Dec 3, 2004

Most of the DNRs I have seen have been very sick, in the final stages of an advanced chronic disease state, or terminal. We did have one gentleman (when I was working in the cardiac stepdown) who was in his 60's and chronically ill with heart disease, though still relatively healthy. He was a DNR. He was very much at peace with himself and with the idea of death (not that he was wanting to die), and this was his choice. We still gave him the utmost quality of care during his stay (DNR does NOT equal DO NOT CARE), and he was discharged home without any complications.

talaxandra · Dec 3, 2004

I was in hospital last year for elective oral surgery (overnight stay). I'm healthy, have no significant medical hsitory, and was thirty four. I also said that in the event of an unwitnessed arrest I didn't want to be resussed. As Kevin said, this wasn't valid for the surgery, and of course I would hardly be unwitnessed there or recovery! Treatment for anaphylaxis? Yes! Unknown down time? No thanks!

jwk · Dec 3, 2004

Something to remember. All DNR orders are suspended when a patient goes to the OR. This holds true for the C-Section suite, as well. There are reasons for this, but the short version is we will not stand idly by while the patient dies from a minor reaction to anesthesia or surgery that could easily be rectified.
I have taken a number of DNR patients to the OR, and am always careful to explain to them that the DNR order will be suspended during surgery and the immediate post operative period, and why this is so. My guess is that the anesthetist explained this to your c-section patient as well.
In short: There ain't no DNR's in the OR.
Kevin McHugh, CRNA

In general, there shouldn't be DNR's in the OR, BUT it needs to be spelled out in a hospital policy. It's not as simple as having an "understanding", or that "everyone knows this". There should be a formal, written policy that covers this type of situation, because it really is not all that unusual.

And, we still operate on some patients with DNR's that are specifically NOT suspended in the OR. It's not a straight-forward black and white situation. I agree with Kevin that we would not stand by and let someone die from a simply-corrected situation, but again, there are gray areas to consider.

There's also some public policy concerns that would come into play with adults with young children. A case could be made that the state has an interest in making sure minor children have living parents that raise and support them. Simply stating that you want to be DNR in ANY cardiac arrest situation from any cause raises concerns beyond self-determination.

pricklypear · Dec 3, 2004

This DNR in OR problem has been an issue at my hospital. We had several incidents involving DNR patients being coded in PACU or in ICU immediately post-op and had to deal with some very irate family members. The rumor was that "all DNR orders are automatically null and void during surgery and for the immediate post-op recovery period" We looked up specific policies for our hospital and found no such protocol, practice guideline or policy. Our DNR policy is if there is a DNR order on the chart, the patient is a DNR until the order is reversed by a physician's order with the consent of the patient/POA. Our surgical consents have a specific signiture area regarding suspension of DNR orders. If this area is NOT signed, the patient remains a DNR. I have only seen this used once. It was for a terminally ill man who underwent elective abdominal surgery to relieve pain from a severe colon/stomach cancer. The patient signed the suspension area, he was a full code for 48 hours following surgery. Personally, I have never heard an anesthesiologist, surgeon or anybody else address DNR status with a patient or family until it's too late. (with the exception above) It is of utmost importance to me to make sure my patient's wishes are honored, and that they are fully aware of everything that is happening to them. People go to a lot of trouble to write living wills, or to make sure their doctor writes a DNR order for them. I hate seeing someone on a vent after a code who specifically did not want that type of treatment, but assumptions had been made by staff. My goal is to get policies re-written to be specific. For instance, what is meant by "the immediate post-op period"? Is this PACU, 24 hours?

Sorry this is so long!! Didn't mean it to be! This is one of my pet peeves. I should say I work in ICU, not PACU or OR. What goes on the the OR isn't my problem, it's when the patient comes to our unit and I get report that "well they're automatically a code for 24 hours" that steam rises from my head.

OK, I'm stepping down from the soapbox!

Katnip, RN · Dec 3, 2004

The last hospital I worked at suspension of DNR was in effect from beginning of surgery to 24 hours post surgery.

I don't know what the current hospital states, since I don't take post-op patients.