DNR Order from Another Facility: Continue Treatment and Verify with Family
When treatment has already been initiated on a pediatric patient and a DNR order from another facility is subsequently discovered, you must continue the ongoing resuscitative efforts until proper verification and documentation occurs at your current facility. 1
Immediate Actions Required
- Do not stop ongoing treatment based solely on discovering a DNR order from another facility 1
- DNR orders from other facilities are not automatically valid at your institution without proper verification and new documentation 1
- The American Heart Association explicitly states that oral DNR orders are unacceptable and that the attending physician must write a new DNR order in accordance with local policy 2
Verification Process
Contact the family immediately to verify the existence and current validity of the DNR order 1. This verification step is critical because:
- DNR orders are not permanent lifetime orders and should be reviewed periodically, particularly when the patient's condition changes 2, 3
- Family understanding and wishes may have evolved since the original DNR order was written 3
- Regulations regarding inter-facility DNR orders vary significantly from state to state, and a separate order must be written for different healthcare settings 1
Documentation Requirements
After family verification, the attending physician must:
- Write a new DNR order in the patient's chart at your facility 1
- Include a note explaining the rationale for the DNR order 2, 1
- Document discussions with the family, including whether their wishes regarding resuscitation have changed 1
- Provide explicit instructions for which specific emergency interventions are to be withheld 1
- Specify which interventions should continue (DNR does not automatically preclude parenteral fluids, nutrition, oxygen, analgesia, sedation, antiarrhythmics, or vasopressors unless specifically included) 2, 1
Critical Pitfall to Avoid
Never assume a DNR order from another facility is automatically valid at your institution without proper verification and documentation 1. This is the most common error and can lead to either unwanted resuscitation or inappropriate withholding of care.
Answer: D - DNR needs to be verified by the provider (with family input), as the attending physician must write a new order with proper documentation at the receiving facility. 2, 1