Protocol 28 Do Not Resuscitate Orders 12/15/2022

Do Not Resuscitate Orders (DNRO) Overview

• DNROs are legal documents expressing a patient’s wish to avoid resuscitation in case of respiratory or cardiac arrest.
• The order ensures medical staff refrain from resuscitation efforts while still providing other necessary medical care.

Valid DNRO Criteria

• Must be an original or completed copy of DH Form 1896, Florida Do Not Resuscitate Order, dated December 2002.
• The form can be legally duplicated on yellow paper, ensuring quality and unaltered content.
• Previous editions of DH Form 1896 are also accepted.
• A DNRO Patient Identification Device may accompany the order, serving as a portable version of form 1896, although its use is voluntary.
• The DNRO must be signed by:
  • The patient's physician.
  • The patient, healthcare surrogate, court-appointed guardian, or an individual with a durable power of attorney.

Confirmation and Documentation

• Patient identity must be confirmed via photo identification or a witness, documented in the ePCR narrative.
• Required witness information includes:
  • Full name, address, and telephone number of the witness.
  • Relationship of the witness to the patient.
• Documentation in ePCR must include:
  • Effective date of the DNRO.
  • Information on any witness used.
  • Name of attending physician who signed the DNRO.
  • Identity of the signer (patient, surrogate, guardian, or proxy).
  • Information regarding the patient's death during transport if applicable.
• A copy of the DNRO must accompany the patient if transported, with personnel relinquishing it to the receiving facility.

Photograph Documentation

• A photograph of the DNRO must be included in the ePCR, accurately reproducing the original form with all details, including yellow background.
• The process for attaching a photo involves:
  • Selecting 'History' and 'Directives.'
  • Adding a photo under 'Scene' with the caption 'DNRO.'

Additional Considerations

• Valid DNROs dictate that personnel should not perform CPR but may provide other medical care.
• Invalid DNROs or absence of a DNRO requires initiation of CPR and other life-saving techniques.
• If CPR begins and a valid DNRO is discovered, resuscitation efforts must cease, with proper documentation required.
• Patients, surrogates, guardians, or proxies can revoke a DNRO at any time, in accordance with section 765.104, FS.

Test your knowledge on Do Not Resuscitate Orders (DNRO) and their legal implications. This quiz covers the purpose, process, and considerations surrounding DNROs and how they relate to patient care. Understand the role of medical personnel when encountering such orders.