How do they post DNR in the patients rooms at your LTC

Danianne · Aug 26, 2005

Don't you start CPR? Our state just mandated every LTC to have an AED. I've been asking to get one for years and was always turned down. Now that they are mandated we'll finally be getting one.

no we are an extended care facility and our policy is when we discover a code that is not DNR we call 911. The families are aware of this policy before they admit their family member.

dbsn00 · Aug 27, 2005

Red round sticker on the ID picture above their bed, a small round sticker on their ID bracelet (when they keep it on)!

dian57 · Sep 10, 2005

All residents with an active DNR order wear blue ID bands. The bands are checked monthly and replaced if they're illegible or missing. We explain advanced directives and what a full code means to every resident and family who attend careplan meetings. We (social worker and myself) also revisit DNR with the family if it looks like a resident is starting to deteriorate significantly and permanently.

I've always thought we should film an actual code and make families watch it on admission, then decide if they want Mama coded or not. I did discuss having DNR tatooed between my breasts with my husband, who found it less than amusing. I was very serious.

We do full codes at my facility, ambu bag, AED, CPR till EMS arrives. With the opening of a rehab unit, we get more and more people in without DNR orders. And they come and go so quickly, it's a good thing they wear those blue or clear ID bands.

Antikigirl, ASN, RN · Sep 13, 2005

We now are mandated to have a POLST (Physicians Order for Life Sustaining Treatment) in each patients room. For us, the residents did agreee that this was something they all wanted, because in the past you had to run down a hall, into a med room, find their chart and hope to goodness there was one!

Both DNR's and total implementation residents like having them in their rooms on the fridge so that if the nurse comes in..they can take just a second to find out what they can and can't do...and in most cases...that second counts! Me, if I don't SEE a POLST, I treat!!!!! And so having a caregiver run to the charts while I am doing CPR only to find out they don't want it...well...I have saved them before (never got in any trouble either...I followed the letter of the law on those!). Or a person that wants all measures getting it that very second I see them!

We have them in clear folders on the side of their fridges, and even paramedics know that and where to look. We still have to go to the charts to get their med lists and copy them...but keeping those updated with the POLSTS would take a act of God with as many med changes happen with most my patients a week/month!

My facility works closely with EMS, and my hubby is a paramedic and the ambulance company that works our county (we have private) knows me well, and I am basically the PR for our facility with them. I even attend classes there for free to learn the latest so I can help bridge the gap in emergencies to the fullest making their and my job easier and helping residents quickly (seconds count in most cases).

For people that do not want a DNR order on their fridge...we have a second option. First door in their kitchen cabinets on the inside! That way they don't have to see it everytime they go to the fridge..but so far they all want them on the fridge!

DutchgirlRN, ASN, RN · Sep 14, 2005

Everywhere I have worked there is a place in the room where it states DNR. This facility posts a heart if they are a code. I would much prefer knowing a patient is a dnr without having to look for where ever the heart might be. Maybe if the hearts were all in the same place would help.
Also is there a specific spot in your facility where new orders are put?

Posting a DNR in a room would be a HIPPA violation. We have a sticker on the front of the chart and that is all. I like the heart idea. I'll have to mention it.

Jubei · Sep 23, 2005

We don't. It's a HIPAA thing.

rjflyn, ASN, RN · Sep 23, 2005

I know of one LTC that it was easy- all were DNR- they didnt take pts that were not. As a side to that as I recall I dont think there staff even had to have CPR certs.

RJ

Daytonite, BSN, RN · Sep 28, 2005

I've seen two ways of indicating a patients code status in nursing homes lately. In one place, a blue dot was placed on the patient's overbed light box as well as next to their name plate by the door of their room, and on the spine of their chart. I've also seen places that placed a blue plastic arm band on the DNR patients. Recently, it seems that for confidentiality reasons a lot of places are discouraging any kind of written signs to be hung around the patient's bed. Goodbye turning clocks and signs advising a patient is NPO.

I found that in some places just about everyone was a DNR, so it was easier to just keep a list of who was to be coded--it wasn't that long. When I worked on a Medicare wing I marked my "brains" very clearly for anyone who was a DNR, so it was always in my eyesight.

blirms · Sep 30, 2005

Everywhere I have worked there is a place in the room where it states DNR. This facility posts a heart if they are a code. I would much prefer knowing a patient is a dnr without having to look for where ever the heart might be. Maybe if the hearts were all in the same place would help.
Also is there a specific spot in your facility where new orders are put?

At our facility residents do not wear any type of ID band. We use the small picture of a stop sign taped on the outside of resident chart and on the headboard. Just make sure the right resident is in the correct bed.

Cubby · Oct 1, 2005

We had so much trouble with this. HIPPA and all! The way that works best for my unit is on the daily assignment sheets there is a list of all the residents names. If they are a DNR their name is in BOLD type, if they are a full code their name is listed in regular type. Everyone has their patient list with them at all times, so it is easy to figure out who is a code and who is not. Hope this helps

CyndieRN2007 · Jan 3, 2006

We don't post anything in the patients' rooms, either. And they don't wear name bands. We just have to look at their charts. Aside from the paperwork on the inside of the chart, we use a large green sticker dot, about the size of a nickle, on the outside, next the the patient's name if they are a full code. For DNR we use a red one. There are not a lot of pts. who are full codes, though, so we usually just know the ones who are. The sticker dot thing works well, though.

I am an RN student. In my clinical rotations in LTC I found the charts very confusing when DNRs were concerned. Some charts had the DNR dot and the Full Code dot and with advanced directives paperwork within the chart. I had to investigate with the nurses to get the DNR status of the resident and I found this alarming. I know I am just a studnet but it should be very easy to find the advanced directives of the residents so even us "rookie" student nurses can find them.

dinkymouse · Jan 5, 2006

When I started this post it was just a hypothetical question but in the past few weeks it has become a reality. I was the only nurse on one night when a patient went into cardiac arrest in the dining room. His chart was clear down on the other end of the building and I had to send someone down there to check. Luckily I didn't start start CPR and he started breathing after we threw him to the floor and I did a sternal rub. I then found out he was a no code. Even doing the sternal rub was apparently against our dnr policy. A few days ago a new RN had a patient die, she sent someone down to find out if she was dnr and the aide came back and said yes she was dnr. Unfortunately she looked in the wrong chart and this woman was a code. They didn't realize the mistake until after they had called the family. This was an unexpected death so none of us were prepared for it and she was a wonderful lady. The RN quit over this and so I am again the only non management RN.