Signed State DNR form no good????

Lorie P. · Mar 9, 2009

i understand the frustration! we once admitted a nursing home pt that had a dnr/living will, she coded, the er doc, says wait this lady has a dnr and the house super says but it isn't on a hospital form and we have to code her. at the same time the er doc calls primary doc who says pt is a dnr, same thing, house supervisor says it's not written in the orders and not on hospital dnr form. saved the lady, sent her to icu and when family showed up was ****** off that the pt was coded. when pt became alert and oriented, she was ****** off cause she was coded!

never did find out what the final out come was. but what good is a dnr/living will if it isn't on proper hospital forms? yet the primary doc can write dnr on physicians orders and that is fine!..

one of the many reasons i left bed side nursing.

rjflyn, ASN, RN · Mar 9, 2009

Well I know its getting better with EMR's and the like, we can actually look up a pts chart and have a copy of the living will if they have been there before. If not its best to always bring a current copy of your advanced directives with you. If your in a facility they need to make sure they send all appropriate papers with you so that you dont get coded. In Nurse Hobbits case not much they could sue for, as the harm is the saved the pt.

I know I for one am bad, I have yet to put me desires on paper. At least my wife knows that if something happens and I am not going to be able to walk out of the hospital and eat real food to pull the plug. No feeding tubes, no further resuscitation.

caroladybelle, BSN, RN · Mar 9, 2009

I have seen MDs repeatedly ignore Florida DNR forms. REPEATLY!!!!!!!!!!!!!!!!

Aneroo, LPN · Mar 12, 2009

I think this discussion illustrates the importance of having a MPOA designated and ensuring that person believes the same way you do. A MPOA does not have to be a family member and sometimes it's probably better if they're not. My MPOA is my wife but she's also a hospice nurse and we agree on heroic measures. Also, she knows if she goes against my advanced directives I'll come back and haunt her!

My husband and I are the same way. We talk about my cousin, who had a CHI, and is now in a nursing home. She's 26. :banghead: We both know we'd have taken the other off the vent a long time ago. Now she's stuck with a feeding tube that she pulls our constantly- MAYBE she's trying to tell someone to let her die!

Well I know its getting better with EMR's and the like, we can actually look up a pts chart and have a copy of the living will if they have been there before.

To play devil's advocate- what if the DNR or living will was rescended, you don't code when they're now a full code?

rjflyn, ASN, RN · Mar 12, 2009

My husband and I are the same way. We talk about my cousin, who had a CHI, and is now in a nursing home. She's 26. We both know we'd have taken the other off the vent a long time ago. Now she's stuck with a feeding tube that she pulls our constantly- MAYBE she's trying to tell someone to let her die!
To play devil's advocate- what if the DNR or living will was rescended, you don't code when they're now a full code?

A reasonable question. Hospitals have been mandated for years to ask with each admission of patients/families if they have any advanced directives. If so they then ask for a copy, most in my experience ask for a copy every time even if they have one on file. If you dont have a copy they generally ask if anything has changed, specifically more towards the POA aspect. But it can effect the living will portion- personally I have never seen this. Most people who have take the steps to complete one are set with their wishes. An exception might be someone young with terminal cancer who through a miracle survives and becomes cancer free. Along with that mandate the hospital is required to provide you/family with information about advanced directives with each admission.

I guess what I am saying is the onus is on the pt and their family to make sure their desires are clearly and explicitly spelled out and that those are with them at ALL times.

R

llltapp · Mar 21, 2009

I agree. Problem with my patient and why I posted was that this patient had an ORIGINAL, yellow, signed, state DNR form with him. Doc refused to write DNR order til she spoke to family, who wasn't around........ unable to contact. If the patient HAD DNR tatooed on his chest, this doc probably would have wanted to verify with nonexistent family first lol

KNARE · Mar 26, 2009

Actually I know a Paramedic who has DNR tatoo'd on her chest just above her cleavage!!! Wonder if it will be honored.... We have all of the same issues as stated above. Our ED physicians are much better regarding honoring the state DRN form. We have problems with the Attending MD honoring the pt. wishes so they admit with orders for DNRCC-Arrest... which means do everything up until the time the heart stops beating. This order buys a tele bed / Unit Bed and everything but chest compressions and defibbing. Doesn't matter that a pt. didn't want all that. Sighhhhhhh

rjflyn, ASN, RN · Mar 26, 2009

They problem is the gray area. If one doctor or nurse for that matter gives even just one family member any faint chance of hope it well pardon me screws up the whole system.

I still have my favorite nursing home, it was ahead of its time even in the mid 1990's, if you were placed there you were a DNR period. We dont do CPR. NO staff is trained in it. NO staff will be trained in it ever. They did have on man who was a legacy hold over from when they switched this policy who was a full code who knew if he arrested that he was on his own possibly until we as EMS could get there- about 9 mins on a good day.

Long Term Care Columnist / Guide · Mar 26, 2009

Well, my doctor didn't much like doing it, but I bullied him into signing a DNR order for me at my last visit. He said, "You're too young to have a DNR." I said, "You and I both know what happens during a code. If my breathing and heartbeat have stopped, I don't want to be brought back and then have to live on a vent, turned and basted every 2 hours, and fed through a tube." It's as simple as that...........age has little to do with it.

And where is that order located today? Copies of it are in my medical record, at the hospital, at my attorney's office, and tacked onto the side of my refrigerator at home, lest there be ANY doubts about the way I want things to be done.

Besides, as I told my family: y'all get selfish and try to put me on life support, I will find some way to die and then haunt you for the rest of your days.........that's how I roll.

Jess_Missouri_RN · Nov 27, 2011

Nursing home/state/etc. DNR's do not apply at our hospital, all pts are full code unless the admitting MD signs our blue DNR form, period. If the form is not filled out and in the chart, we code.

mmutk, BSN, RN, EMT-I · Nov 28, 2011

To me also, a patient's wishes should override EVERYTHING.

I have had the same type of problem with families. As soon as things go south they start revoking the patient's wishes. Sad

mmutk, BSN, RN, EMT-I · Nov 28, 2011

Nursing home/state/etc. DNR's do not apply at our hospital, all pts are full code unless the admitting MD signs our blue DNR form, period. If the form is not filled out and in the chart, we code.

I wonder where they get the rationale for this, what court case do they refer to where it allows a hospital to override a patient's wishes?