Help! Confused about DNR status!

RNBearColumbus, BSN · Aug 14, 2012

In the state I used to work in we had full code or DNR which was simple. Now I'm working in a state where we have Full code, DNR CC (comfort care), and DNR CCA (comfort care arrest). I'm in orientation and have asked several nurses about this and either get vague or conflicting answers. Do you call a code for the DNR CCA? I know you can't intubate them but one said they can get chest compressions and one said they can do whatever it takes up until they arrest and then you stop-no compressions. Does anyone know for sure? I find this so confusing!

I deal with this a lot as a LTC nurse, often having to guide families through the process of determining which code status is appropriate for their loved one.

Here's the best way I've found to understand / explain the difference:

Full Code:

all the bells and whistles. CPR , intubation etc. All efforts will be made to keep the patient alive.

DNR-CCA:

Everything is done for he patient to maintain life up to the point where the heart or lungs stop working.. For example, ATBs given to treat pneumonia, but if the patient stops breathing, that's it. No CPR, no intubation, etc. New emerging conditions will be treated.

DNR-CC:

most meds used to treat illness are DCed, ( Coumadin, ATBs, lasix, etc. ) but meds used to promote comfort are continued ( atropine for secretions, morphine for pain, Ativan for terminal restlessness). Any new illnesses will not be treated, but symptoms will be managed to promote comfort.

Nurse ABC · Aug 14, 2012

Ok-that helps. Now it's starting to make sense. Thank you!!

chare · Aug 14, 2012

I am not sure which state you are from, so the following might not apply as it pertains to Ohio.

In Ohio, when a DNR order is initiated, it can either be written as a DNR Comfort Care (DNRCC) or DNR Comfort Care - Arrest (DNRCC-A). The option selected determines when the DNR becomes effective. The DNRCC becomes effective when it is signed. The DNRCC-A becomes effective when the patient presents in either cardiac and/or respiratory arrest.

At the time the DNR becomes effective, none of the following interventions are to be initiated:

Start chest compressions
Insert an artificial airway
Administer resuscitation drugs
Defibrillate or cardiovert
Administer respiratory assistance
Use resuscitative IV lines
Initiate cardiac monitoring

Likewise, all of the following interventions can be initiated at any time:

Suction the airway
Administer oxygen
Provide pain medications
Position for comfort
Splint or immobilize
Control bleeding
Provide emotional support; contact other health care providers

Contrary to popular opinion, a valid DNR order does not equal a "do not treat" order. What this means, however, is that medications and treatments for chronic medical conditions are maintained. If new conditions arise, they will likely be treated as well.

If you are in Ohio, the Ohio Department of Health website contains an information page pertaining to the Do Not Resuscitate Comfort Care program. There is also a frequently asked questions page that might answer many, if not all, of your questions.

Nurse ABC · Aug 14, 2012

Thank you! I looked that up and it helped as well. We actually had a patient with a dr's order that said he was a DNRCCA with chest compressions. That really confused me! So unless it states otherwise, no codes with DNR's. I think that's a dangerous order for the pt!