What to Do When DNR Order from Another Facility is Discovered After Treatment Initiation
Continue the treatment already initiated and immediately verify the DNR order with the family and document a new DNR order at your facility through the attending physician—DNR orders from other facilities are not automatically valid and require re-evaluation and new documentation at the receiving facility. 1
Immediate Actions Required
- Do not stop ongoing resuscitative efforts based solely on discovering a DNR order from another facility 1
- Continue all treatment already initiated until proper verification and documentation occurs at your current facility 1
- The American Heart Association explicitly states that oral DNR orders are unacceptable—all DNR orders must be written by a licensed physician in the current facility's medical record 2
Verification Process
Contact the family immediately to verify both the existence and current validity of the DNR order 1. This is critical because:
- DNR orders are not permanent lifetime orders and must be reviewed periodically, particularly when the patient's condition changes 2, 3
- The family's understanding and wishes may have evolved since the original DNR order was written 3
- You must document whether their wishes regarding resuscitation have changed 1
Documentation Requirements at Your Facility
The attending physician at your facility must write a new DNR order that includes 2, 1:
- Written documentation in accordance with local policy in the patient's chart
- A note explaining the rationale for the DNR order
- Documentation of discussions with the family (since this is a 15-month-old pediatric patient)
- Explicit instructions for which specific emergency interventions are to be withheld
- Clarification of which interventions should continue (parenteral fluids, nutrition, oxygen, analgesia, sedation, antiarrhythmics, or vasopressors are NOT automatically withheld unless specifically included) 2, 1
Critical Considerations for Inter-Facility DNR Orders
DNR orders from other facilities require re-evaluation and new documentation at the receiving facility 1. This is because:
- Regulations regarding out-of-hospital and inter-facility DNR orders vary significantly from state to state 1
- A separate order must be written for different healthcare settings 1
- The patient's clinical condition may have changed since the original order was written 2, 3
Common Pitfalls to Avoid
- Never assume a DNR order from another facility is automatically valid at your institution without proper verification and documentation 1
- Do not confuse a DNR order with a complete limitation of care—DNR orders do not automatically preclude other interventions unless specifically stated 2, 1
- Avoid assuming DNR orders are permanent—they must be actively maintained through physician review and documentation 3
Answer to the Multiple Choice Question
The correct answer is D: DNR needs to be verified by the provider. The attending physician at your facility must verify the DNR order through family discussion, then write a new DNR order with proper documentation at your institution 2, 1. DNR orders from other facilities are not automatically transferable and require physician verification and new documentation at the receiving facility 1.