Would you call a code/MET on a pt. who is a complete DNR?

KelRN215, BSN, RN · Sep 2, 2013

MRT yes. Code? No.. I guess im confused what you mean by "complete" DNR. Because in my experience there is no "half DNR". you are either DNR or you are not, there is no in between.
But to answer your question...Yes, you could call an MRT. A DNR is different from P-DNR (if that's what you meant by complete?). But a P-DNR you do nothing except make them comfortable through that process.
just a DNR, yes you would call an MRT. Although you would not to CPR if it came to that, there are other measures that could be taken. Maybe their blood sugar was low and they just needed a little D5. Or maybe they need a little Lasix? You never know. DNR, you still can medicate and still do every measure except CPR (and intubate in some cases). So..yea, you would call an MRT for a DNR but not a P-DNR. get it?

I've seen many "modified DNRs" in my days of pediatrics. Basically they could modify a DNR to be anything the family wanted it to be. I've seen DNRs/DNIs written with exceptions like "may intubate for primary respiratory failure if family is not present. Call family and they will come to the hospital and decide whether or not to extubate."

CaitlynRNBSN · Sep 2, 2013

I've seen many "modified DNRs" in my days of pediatrics. Basically they could modify a DNR to be anything the family wanted it to be. I've seen DNRs/DNIs written with exceptions like "may intubate for primary respiratory failure if family is not present. Call family and they will come to the hospital and decide whether or not to extubate."

If they are allowed to intubate than they are NOT a "DNI" status. That DNI stands for "Do Not Intubate" so basically you are saying in an emergency the child is DNI but allowed to intubate and family will decide later?? That isn't a DNI status. Either you intubate in an emergency or you don't. Making "special circumstances" is screaming for an error to be made. Making you, the doctor and the hospital liable for doing the wrong thing.

you get intubated or you don't. There is no "call the family first" or anything like that. If family wishes to decide later weather to extubate or not, than they are NOT a "DNI" because that tells us what to do during an emergency. Family can decide later, yes I agree with that.

Basically what im getting at, is that having exeptions to the rule and personalizing a code status is just asking for an error to happen (like I said before) maybe it is different in the pediatrics world?? I don't know. I work with Adults. Either you get CPR or you don't. Either you get intubated or you don't.

KelRN215, BSN, RN · Sep 3, 2013

If they are allowed to intubate than they are NOT a "DNI" status. That DNI stands for "Do Not Intubate" so basically you are saying in an emergency the child is DNI but allowed to intubate and family will decide later?? That isn't a DNI status. Either you intubate in an emergency or you don't. Making "special circumstances" is screaming for an error to be made. Making you, the doctor and the hospital liable for doing the wrong thing.
you get intubated or you don't. There is no "call the family first" or anything like that. If family wishes to decide later weather to extubate or not, than they are NOT a "DNI" because that tells us what to do during an emergency. Family can decide later, yes I agree with that.
Basically what im getting at, is that having exeptions to the rule and personalizing a code status is just asking for an error to happen (like I said before) maybe it is different in the pediatrics world?? I don't know. I work with Adults. Either you get CPR or you don't. Either you get intubated or you don't.

Not just in any emergency, in very specific circumstances. Most of the time, the ones I've seen are written to keep the child alive if the parents are not present so that they can be called in and be at the bedside when the child passes.

Everything is different in pediatrics and almost nothing is black and white. Pretty much every DNR order I've ever seen was personalized to what the parents want. I've seen many "Do Not Intubate" but with exceptions such as I stated above "may intubate if parents are not at bedside in the case of xyz." I've even seen things as specific as "may intubate for respiratory distress caused by seizure activity" but not other situations. One of my primary patients had an aggressive malignant brain tumor and was a DNR only in certain situations and it was changed at least 5 times over the last 6 months of her life.