question about DNRs

I had a patient the other day who came in with an out of hospital DNR (he had been in a nursing home prior to admission) and I know per our hospital policy a new in hospital DNR form has to be signed by the physician when they are admitted otherwise they are technically a full code still.

Is this per written policy and procedure, or did someone else tell you this?

My state has a uniform DNR form, and the transferred patient who has one sent over upon transfer is a DNR, regardless of the form signed or not signed in the hospital. That's the entire purpose of a state-promulgated DNR form.

Agree with checking with state regulations as the ultimate source of information regarding inter-facility DNR orders. In California, we use the POLST form (Physician Orders for Life-Sustaining Treatment) which is valid anywhere the patient goes in California.

CA-POLST-form-web_english.pdf

Also, even if your state doesn't have official say on the matter, it is very irresponsible of the admitting provider to not address code status when admitting a patient to the hospital. There are times when a patient gets hospitalized with a pre-admission advanced directive that states DNR/DNI but the patient and the family will revoke the DNR/DNI order and will allow intubation if the admission is for a treatable or reversible condition (i.e., going to elective surgery, treatment of respiratory failure from pneumonia). DNR/DNI orders should be established before the patient even gets admitted to any hospital unit and clearly communicated to nursing staff.

I would check out the situation you are describing. Where I am if they have a DNR in place and the form has travelled with them then they are still a DNR.

You need to check with your particular state. In my state it used to be that DNR's were not honored by EMS although they would try real hard no to do anything too advanced. my state enacted a "Comfort Care" order. In 2000, Massachusetts, emergency medical technicians are required by law to attempt resuscitation when they are called to a medical emergency at a person's home. It does not matter that the patient may have signed DNR's at both the hospital and rehabilitation facility - EMTs are legally required to attempt resuscitation when responding to an out-of-hospital emergency medical crisis. More and more states have adopted this type of legislation to prevent the necessary and invasive resuscitation efforts.

To honor a parent's wish for a DNR in a home setting, Massachusetts developed the Comfort Care/DNR Program. (Comfort Care - Do Not Resuscitate (DNR) Order Verification Program - Health and Human Services - Mass.Gov)

This program provides for uniform, statewide verification of a DNR when the patient is living at home. It is not an actual DNR order, but instead informs medical first responders that the patient has a valid DNR order on file. The Comfort Care/DNR form is the only program that legally allows the EMTs to not attempt resuscitation if they respond to an emergency in home. Instead, EMTs may provide care that relieves symptoms, but not the underlying cause of the symptoms - Comfort Care.

Any person with a valid DNR order may enroll in the Comfort Care/DNR program. The form for the Comfort Care/DNR program is available for download, but the form must be signed by an attending physician, nurse practitioner, or authorized physician assistant. It is important that the form be properly completed and signed by the correct medical professional, or EMTs will be required to attempt resuscitation. The Comfort Care/DNR Protocol in Massachusetts - Massachusetts Elder Law and Estate Planning Lawyer Blog

I hope this helps you.