DNR orders

My patient has expressed that they don’t want to be resuscitated. What should i consider when assessing the need for a do-not-resuscitate (DNR) order?

What is an order?

An order is a prescription for a procedure, treatment, drug, or activity. A nurse may require a DNR order if it is part of a patient’s care plan (see Scope of Practice standard)). The need for an order is dependent on legislation governing the practice setting and employer policies.

Legislative requirements

Legislation governing certain practice settings, such as community or homecare settings, do not require an order for a treatment. Whereas other practice settings, such as public hospitals do. It’s important to understand the legislation to determine if a DNR order is required in your practice setting.

Employer policies

Employer policies may also require an order for DNR. Nurses need to be aware of their employers’ expectations regarding obtaining an order for DNR (if applicable) and ensuring this information is documented in the patients care plan.

Consent

Consent is required for all care plans, including treatments or refusal of treatment. Nurses must also ensure they document the patient’s consent and resuscitation status in the patient’s chart. Nurses must also communicate this information to the healthcare team.

My patient has a signed DNR confirmation (DNR-C) form. As an RPN working in homecare, can I follow the DNR-C in the community?

Yes, you can, as the DNR-C is part of the patient’s care plan. However, the form DNR-C is not a “DNR” order. You are advised to check your organization’s policy to determine if an order for a DNR is required. Nurses should always check whether their patient’s care plan reflects their resuscitation status and their employer policies on how the organization communicates patients’ resuscitation status among the healthcare team.

The purpose of the DNR-C form is to provide direction to emergency responders (i.e., paramedics and firefighters) in the community regarding a patient’s resuscitation status.