In a young patient with muscular dystrophy transferred to a tertiary hospital, is a Do‑Not‑Resuscitate (DNR) order valid across hospitals for 24 hours?

DNR Order Validity Across Hospitals

D) Any of the team members can verify DNR orders is the correct answer. When a DNR order from another facility is discovered after resuscitation has begun, the American Heart Association guidelines explicitly state that treatment already initiated should continue until proper verification occurs, and any team member can participate in this verification process by contacting the family and reviewing documentation 1.

Why the Other Options Are Incorrect

Option A is Wrong: DNR Orders Can Transfer Between Facilities

• DNR orders are not automatically invalid when a patient transfers between hospitals 1
• However, they require proper verification and re-documentation at the receiving facility before being honored 1
• The key issue is not validity but rather the need for proper documentation in the new facility's medical record 1

Option B is Wrong: No Automatic 24-Hour Validity Period

• There is no standard 24-hour automatic validity period for DNR orders transferring between hospitals 1
• The 24-48 hour timeframe mentioned in stroke guidelines refers to postponing new DNR orders in acute conditions like intracerebral hemorrhage, not to inter-facility transfer validity 2
• DNR orders from other facilities require immediate verification and new documentation regardless of timing 1

Option C is Misleading: Verification is a Team Responsibility

• While family contact is essential for verification, identifying and verifying DNR orders is not solely the parents' duty 1
• The healthcare team has the primary responsibility to identify, verify, and properly document DNR status 1

What Should Happen in This Scenario

Immediate Actions Required

• Continue resuscitation that has already been initiated until proper verification occurs 1
• Do not stop ongoing resuscitative efforts based solely on discovering a DNR order from another facility 1

Verification Process

• Contact the family immediately to verify the existence and current validity of the DNR order 1
• Any team member can participate in this verification process by contacting family and reviewing available documentation 1
• Document the conversation thoroughly, including whether the family's wishes regarding resuscitation have changed 1

Documentation Requirements

• The attending physician must write a new DNR order in accordance with local policy in the patient's chart 1
• Include a note explaining the rationale and document discussions with the patient's family 1
• Oral DNR orders are explicitly unacceptable 1
• Specify which interventions are to be withheld and which should continue 1

Critical Considerations for This Patient Population

Special Issues in Muscular Dystrophy

• Patients with muscular dystrophy may have pre-existing DNR orders due to progressive respiratory and cardiac complications 3
• These patients often have complex advance care planning that should be respected once properly verified 1

State-Specific Regulations

• Regulations regarding inter-facility DNR orders vary significantly from state to state 1
• A separate order must be written for different healthcare settings 1

Common Pitfalls to Avoid

• Never assume a DNR order from another facility is automatically valid at your institution without proper verification and documentation 1
• Never stop resuscitation already in progress based solely on verbal reports of a DNR order from another facility 1
• Remember that DNR orders do not automatically preclude other interventions such as oxygen, IV fluids, antibiotics, pain management, or vasopressors unless specifically stated 1, 4
• Avoid delays in verification—contact the family immediately while continuing appropriate care 1