DNR status.

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Do people know that in Pennsylvania if a nursing home patient has a change in mental status and transferred to a Geri/Psych unit for "change in mental status" you need to get the DNR re-activated in the transfer facility.


I believe that any time you go to the hospital, you need toreassert the DNR, DNI and whatever other advanced directives the patient has
I'm not sure exactly what you are trying to say, I think it would be common practice to establish the DNR status when you transfer to any different facility, you can't count on those records to follow the patient. I know when my mom had a respite stay at a nursing home DNR was discussed and I'm sure that it would be asked again if she was ever admitted to a hospital. We also have her original DNR here at home in her nursing care binder and I would certainly make sure any first responders are aware of it.
I was a nurse at at Geri/psych unit and would get "change in mental status" patients ( usually from UTI) and didn't realize at first that when a patient transferred from nursing home with "change of mental status" and they were a DNR at previous facility the DNR didn't transfer. That was in PA. I was an advocate for new admits to notify families and got the DNR's re-instated. I want to get the word out for families that don't know. There was an elderly patient/dementia that came in, coded was recessatated and transferred to ICU. I wasn't working that day, but when my Mom died in 2003 and had dementia it was a blessing she passed. I mourned her living body and dying mind for a decade.
Martina, are you saying that only patients with "change in mental status" need to be concerned about transferring DNRs or could it be that, working in the geri/psych unit, those were the only ones you were aware of? It would make sense that DNRs would need to be established for any new admit, regardless of the department.
I'm a huge DNR advocate. I know it's a personal/spiritual private decision but I have witnessed health care facilities gently say to families "do you want us to do everything possible" to make your family live? And I think families interpret that as pillows, food and comfort measures....not a full recessatate code. I used to work in surgery with patients with ruptured aortic aneurysm. 90 percent fatality rate if not dx within hour. There was often a decision made by family to medicate for comfort ( IV morphine) or surgery. Those cases there is so much activity getting IVs, foley central lines etc....I made it a priority to sit by patient OR table hold there hand because I wanted to assure them that their family loves them and they would be ok. It was unacceptable to me to not have another human being comforting and talking and holding there hand when I knew there was very little hope. Personally I would choose the morphine drip. But that's me and my belief
I also worked with terminal pediatric patients that were blind, had physical disabilities known at birth and cancer that lead to viral infections from suppressed immune systems that started getting amputations. Everywhere. I mean everywhere. I witnessed a family member kiss her brothers leg before being taken to OR to amputate a leg. Then fingers. Then eyes blinded. Then private parts. I respect the parents decision that a miracle would happen and I'm a Christian and spiritual, believe in after life. I also did and respected all wishes of family. I deeply remorsed this patient "surviving" for almost a year. I believe everything happens for a reason and maybe we should linger to learn compassion, live, caring. I also believe that without medical intervention if it is GODs wish to have an individual return home that it's ok to DNR. I just don't want anyone to die without another human being being with them and living them unconditionally
I was with my cousin at a dental appointment recently. He was just going to extract three teeth, with local only. He asked if she was DNR and when I said yes, he asked if the DNR order was in her notebook. (Held by the Memory Care transport person). He has to see it. When we discovered it was located in the OFFICE of the Memory Care, he refused to proceed. I understood and we rescheduled, making sure the DNR was in the notebook next time. The dentist office was so apologetic, but I understand completely why he made that decision and had no issue with it at all. Oh, the next time, everything went fine.
Please have a copy of that with you and your cousin at all times in a wallet etc. I would hate a full code to happen if not wanted. I think there should be ( maybe there are) DNR bracelets. But with government and legal BS that probably wouldn't be enough. Prob have to pay a fee...what would stop someone to just put that bracelet on
I work in a hospital and we all joke (not) that we are going to have it tatooed on our chests...
I thought about copies too, but I was led to believe that they have to see the original document. ??? She does have a DNR sign by her bed. I'll have to research that.

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