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

allele, LPN · Jan 5, 2006

Our DNR patients wear a blank red bracelet/band. The only problem I have found is SOMETIMES we get transfers from other hospitals that use red bracelets for allergy alerts. I always look when I get a transfer. :)

Daytonite, BSN, RN · Jan 6, 2006

hi, dinkymouse! it's been awhile since you've done any posting. could i make a suggestion to you that might help put your mind at ease over this issue? at least this is what i would do in your situation with a concern over who is and who isn't a dnr. i would first start with my own regular group of patients and make a list of who has a dnr order. by default (unless you also have orders for who is a full code), the remainder of the patients will be full codes. which ever list is shorter is the one i would keep with me at all times on my clipboard. review the short list regularly, so it gets burned in your mind. that way, when something like this should happen again you'll know where to access your information immediately. if you wear a badge that clips to your uniform or is on a lanyard that is about 2 inches x 3 inches, you can write out your short list of dnrs or full codes and scotch tape it to the back of your name badge which you will always have on and can access immediately.

actually, this information should be retrievable from the company that prints your mars/tars/doctor's orders. since all the information is in a database, they should be able to print out a listing of all dnr orders at the time they do the monthly print outs. i found that our don was getting all kinds of lists printed out every month from the pharmacy service that did our orders which is how i discovered this could be done some years ago. another easier way to do this is to grab the packet of newly printed monthly doctor's orders before they are put into the charts and look for these orders. at the last facility i worked every patient had to have either a dnr or a full code order. i made a list of those and kept it on my clipboard at all times, re-checked it every month against the new printing of orders, updating it when a new patient was admitted or a new dnr order written. i also kept active lists on my clipboard of falls, people on antibiotics, and people with tube feedings with their formulas. i also started checking charts everynight for new orders (just like in the hospital) to make sure new orders were being processed and had bee started through the system to help the reconciling process at the end of the month move along faster. several years ago when i was working nights at a ltc and was responsible for checking all the new months orders/mars/tars for any errors before putting them out on the first of each month, i learned a lot about how these orders were processed in the computers by making a number of calls to the computer service. it's one of the things that got me started with changing to a career in health information management as my back was deteriorating.

LadyJRN · Jan 6, 2006

At my facility the code status is on the spine of the chart. It is also in the MAR with the resident's picture. I would like to have a place, like on the name bracelet, so in the case of a emergency it would be quicker to identify a full code.

We update our Advance Directives every 90 days at the Resident Care Conference, which coinside with the MDS.

I like the idea of different colored wrist bands, or a colored dot. One problem on the dementia unit is the resident's often take off their wrist bands. We are forever replacing them.

flashpoint · Jan 6, 2006

The last LTC I worked at had red dots on the charts, pink med sheets instead of plain white, red hearts on the over bed light, and red ribbons tied to one of the handles on the WC for all residents that were full codes. They also had a barrier mask taped to the wall in all full code patient's rooms and all residents had charts inside their closet doors with code status, number of staff needed for assist, whether they wore dentures, glasses, hearing aides, what assistive devices they used like walkers, WC, cane, Tabs alarms, Depends...don't remember what else, but you could basically look at their closet door and know about everything you needed to care for any resident...was nice when we had new staff or worked on an unfamiliar hall.

NicInNC, CNA · Mar 12, 2006

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?

In the LTC facility that I work at, there are nameplates beside each doorway on the wall. If the patient is a DNR, then they'll have a little red round sticker beside their name. The stickers are nothing more than those round color coded stickers that people use for yardsales. Stores sometimes use them too.

superbratnurse · Mar 14, 2006

Our facility has red heart stickers on the charts, and on the name cards outside the resident's rooms if they are a DNR.

Also our MARs have the code status on the bottom.

Another thing that is helpful, if you cannot get your facility to get a better system, get a census, and make a list of ppl, who are full codes...this is generally easier, as a majority of our residents are DNRs. Of course this is only feasible if you work in a small facility or in the same area every day.

Your DON or Social work department might have a list of residents' code status also.

Hope this helps!

~Brat

CapeCodMermaid, RN · Mar 15, 2006

I work for a huge corporation. If something goes wrong in one home somewhere, everyone has to put new paperwork in place. It seems someone tried to rescusitate a resident who was a DNR and worse, they didn't try on someone who was a full code.

We've always put a blue highlighter through the name on the spine of the chart as the first indication of DNR. Now we have to have ANOTHER piece of paper in the front of the chart...yellow for full code and purple for DNR (I thought blue paper would be more appropriate, but...) The problem is the paper doesn't always get taken out of the chart when the resident goes home so we had one chart with 2 different papers and of course no name on either.

I always just open the chart to the Advanced Directives section. If the resident has signed for DNR, then they are. We have so many steps to make someone a DNR..they sign, the doc has to write an order and a progress note and then we have them sign a comfort care form the patient travels with.

I'm seriously thinking of getting a huge DNR tatooed on my sternum just so there is no mistaking what I want done.

anniev · Mar 16, 2006

red and green dots on charts and by name at door

jlwlln · Mar 16, 2006

In LTC facility I work at the charts have pink dot on outside of it if they are dnr, is also on bottom of MAR, and our names outside the door are red if DNR, black if not, this helps alot.

CHATSDALE · Mar 16, 2006

at facility where i work part time it is considered a hippa violation to have anything that can be viewed by any visitor or non nursing personnel..nurse who takes report can pass status to support team

ltc

Nursepfv · Mar 16, 2006

In some facilities blue arm bracelets (like hospital ones) and dots on charts. I like the heart idea. The challenge is to update everytime a return from hospital, etc.

Nurse_Pauline · Mar 17, 2006

At our facility it also is a hippa violation to post info in residents rooms or outside the rooms. We have red spine name tags on the charts for a dnr and white for full codes. And we use a red nameband for dnr and a clear one for full codes. But, anytime ive had a resident code i check the advance directives. It only takes a second and id rather not code someone against their wishes or not code someone if that was their wish. Personally, ill be getting tatooed DNR. Thats the safest way!