Healthy 22 y/o mom with DNR

[cabbage patch rn]

I was admitting this soon to be mom of 3 children the other night prior to her repeat c-section and when asked if she had a living will she said that she was a DNR. I was taken back a little by that so I asked her was there any reason why and she said plainly "If it's my time to go then it's my time to go, if the Lord wants to take me He can." Obviously she knew what a DNR meant but I still had a hard time with it. I have to admit that during surgery, I was very nervous and kept praying that nothing out of the ordinary happened to her. I know that my own set of values were coming into play with this scenario because I have kids of my own and I would want everything to be done in the case something happened to me so that I could finish raising them. But I just found this to be odd and never have encountered a situation quite like this in all my years of practice. Any thoughts? Have you ever run into anything like this before?

[rjflyn, ASN, RN]

This one is simple- she may request to be a DNR and may have a living will- which if you read the small print only go into effect once your doctor and a confering physician determine you have a terminal condition. But unless/until the doctor writes an order in my hospital you are not a DNR.

Also having worked EMS if she falls over on the street someone is going to call and she will probalbly be resusitated-i'm not going to look through her purse for a living will.

Rj:rolleyes:

[rjflyn, ASN, RN]

At our hospital all orders written before a patient goes to the OR are automaticly cancelled- ie all the patients orders have to be rewritten when they leave the OR. You might want to check it to things at this angle.

Rj:rolleyes:

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!

[Nalini]

I really think that it is an individuals choice. I don't see myself having a DNR but my husband that is 27 wants to get one and we have had this talk several times. For him it is all about the quality of life he could have after waking up.

[dianah, ASN]

At the last facility where I worked, the "policy" of reversing DNRs during surgery (or other procedures, such as heart caths -- where I work!) was being changed. The surgeon (or person doing the procedure) was to discuss with the pt what his/her wishes would be, in case of an untoward event: would you still want the DNR to be in effect? It was no longer a given that the DNR was suspended. I guess the thought is: approach each case individually, don't just cancel all DNRs.

[pricklypear]

I guess the thought is: approach each case individually, don't just cancel all DNRs.

That sounds like a good policy. I just don't think patients are well informed when they go into surgery regarding their DNR status. Like I said before, people put a lot of thought into making that decision, and shouldn't "automatically" be subjected to a suspension of their rights.

[plumrn, BSN, RN]

We have a form for the patient and/or family, and doctor to sign stating their wishes to suspend the DNR, or continue it through surgery. This form must be placed on the chart and addressed prior to surgery on any DNR pt. This was brought about due to the amount of pts who have poor quality of life, but forced into surgery d/t broken hip, pain relief, etc.

[VivaLasViejas, ASN, RN]

I've been a DNR ever since I participated in my first code at the age of 37. No way do I want to be resuscitated to end up brain-damaged, on a feeding tube or a vent, unable to walk, talk, or ask for someone to change my soiled diapers. If God wants me, He can have me.........I've lived a good and reasonably useful life, and if He decides it's time, who am I to say "Not yet"?