Is DNR status automatically transferable

[SilentfadesRPA]

I have a dear grandmother who is 97 and has been deteriorating for several years with dementia. She has been very clear when she was mentally alert that she wishes no efforts be made to prolong her life. She is now on a floor that provides a skilled level of care in a nsg home and she is a DNR there.

She has been a couple of times admited to local hospital for medical issues (chest pain and a fall).

I am out of state and my mother is her POA. I am wondering if when a patient is tranferred to an acute care facility is the DNR status kept or does my mother have to renew that for each hospitalization. I have a great fear of her having CPR done on her or any efforts to bring her back to life and causing her harm or injury.

Does it vary from institution to institution or does it need to be implemented with each and every hospitalization?

Much thanks

[P_RN, ADN, RN]

Your grandmother should have a paper with her records that goes with her to the hospital. I don't think it's automatically transferred as she probably will have a different physician in the hospital. Is your mom nearby her? She should always give the poa and dnr to the receiving facility, hard copy, not word of mouth.

[Daliadreamer]

I believe it depends on the state you are in. I know in my state, the DNR has to be renewed with each hospitalization, and a doctor's order is needed for each. You even need a separate DNR order for transfer to and from the hospital just in case something happens on route. Make sure your mother knows that she needs to get the appropriate paperwork filled out on every admission, including the nursing home. Even if your grandmother lives in the NH and gets transferred to the hospital, chances are you would need a new DNR order when she returns to the NH, even if she has been a resident there for some time.

Like I said before though, I think it depends on each state.

[Sun0408, ASN, RN]

Not in my state. It does not transfer. A new DNR order must be issues with each visit.

[cherrybreeze, ADN, RN]

Where I live, the DNR needs to be specifically addressed during a hospitalization. That simply means that the doctor has to write an order, after getting permission for the patient or POA (if it is activated, of course). Once that person is discharged, the previous DNR would still be in place.

[annister]

In my neck of the woods it is not transferrable and an order is required upon admission. As well, a DNR for transport does not count when the patient is in the hospital. Without a specific order, a patient is treated as a full code. Are your grandmother's wishes expressed in the form of a legal document such as a living will? I've found that the process of maintaining the wishes of patients (regarding degree of medical intervention) from one facility to another can be very confusing and frustrating. The best advice I can give would be to be sure that whoever is responsible for making such decisions (be it the patient or POA) is proactive in making those wishes known to the HCP any time the patient's situation changes.

[ventmommy]

It depends on the state. Something that has not been mentioned is an EMS DNR. There are states where EMS will NOT recognize a hospital or nursing home DNR. You need a separate DNR in those states. It is very important. I can't tell you how traumatic it is for the family (and me) when we see the DNR taped over the patient's bed in the living room (or wherever they are) but the family freaked out and called 911 and there is no EMS DNR and we are now doing CPR.

[Blackcat99]

No. DNR status is not automatically transferable. The doctor must write a new order each time the patient goes to the hospital. I can understand your fear of someone doing CPR on her. Each time my mother was admitted the first thing I would do is to give them the DNR paperwork. I would then tell the nurses to be sure to get a doctor's order for No DNR. Despite my constant watch to make sure no one would perform CPR on her guess what happened? She went into cardiac arrest when I was with her. The nurse called a "Code Blue." Thank God, I was there when it happened. I couldn't believe it when I saw the "Code team" outside her door. Of course, I stopped them from entering her room. I shudder to think what would have happened if I hadn't been with her at that time.

[MunoRN, RN]

A DNR order is transferrable in many states in the form of a POLST, this link shows which states support the POLST:

http://www.ohsu.edu/polst/

[JenniferSews]

Fortunately it is now transferrable in CO. The original form can be sent with the patient to new facilities, home, anywhere they go. Before the new MOST form started we would still send copies of the DNR along to doctors appointments and hospitalizations when the patient is transferred. You can talk to the skilled nursing facility about comfort or hospice care and stipulate that they call you before they transfer your grandma to a hospital, etc.

[merlee]

The problem sometimes lies in why the pt is being transferred or hospitalized. My MIL is a DNR as it relates to her chronic diagnoses, but if something acute should happen, the DNR needs to be readdressed.

When her dementia becomes severe, she stops eating, etc., she is DNR. When she has a fall, or an acute UTI, she receives appropriate treatment. We got a call from a doc who wanted to know if he should give her IV antibiotics (severe UTI) since she was a DNR.

Oy. We told him to give the ATB. That was about 2 years ago. She is still ambulatory...

[Patchouli]

same here. physician must address dnr status (write order), each time pt is admitted to our hospital.