Other healthcare providers and DNR orders

read2go

Forum Ride Along
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Lately I have been seeing a lot of healthcare providers from outside of EMS mess up when it comes to do not resuscitate orders and I need to vent a little. I should mention I work for a large IFT company. It seems that other healthcare providers do not understand how important a DNR is. Everyone wants their dying wishes to be respected.
Some of the mistakes I have seen include transferring a patient from a nursing facility to the hospital and not giving EMS the DNR, losing or being unable to locate the DNR form, refusing to give EMS the DNR because they only have only one copy, forgetting to have a doctor sign the DNR, home hospice nurses neglecting to give patients' families a signed DNR form to keep in their house for emergencies, etc.

Has anyone else experienced this? Is there anything that can be done?
 

Kevinf

Forum Captain
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Yes, all the time. 9 times out of 10 when someone hands me a DNR it is invalid for one reason or another, whether it be from an ECF, hospital, hospice home, or residence. When that happens you need to be clear about what happens next with whomever is your point of contact if the patient isn't able to represent themselves.

When I get a DNR that doesn't apply to us (protocol requires an PA DOH OOH DNR) I explain that we are required to make a call to an emergency doctor in order to honor it. When I get an OOH DNR that is not properly filled out, I explain what needs done in order to make it valid, and get it done. Ultimately, if for some reason I can't get a valid DNR at all I explain that the patient must be transported as if there was no DNR at all and that the decision will then rest on a doctor on the other end of a phone line and I can't guarantee what his answer will be if the patient should code.

I remember one transport I had done, a 45yo male from a hospital to his home for hospice care. He had a DNR, however it was not signed by a physician. Cue floor nurse running down 7 flights of stairs to the ED for a MD signature, and back up. Cue the look on her face when I point out that the MD signed the line for pregnant patients. Cue nurse making another trip down and back up 7 flights of stairs :D

Why didn't she take the elevator? I have no earthly idea. Wanted the exercise I suppose :)

p.s. if you want to find a standard form that nobody seems able to fill out properly, I shall introduce you to the PMNC.
 
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