Do Not Resuscitate (DNR) designates that in the event of a cardiopulmonary arrest (the heart is no longer pumping blood throughout the body) there will be no cardiopulmonary resuscitation.  At times the designation of DNR is often  thought of as a plan to provide less aggressive care for the resident.  However, the degree of treatment desired by the resident should not be inferred from the DNR designation.  A DNR order "does not indicate that the resident is declining appropriate treatment and services.  It only indicates that the resident should not be resuscitated if respirations and/or cardiac functions cease." (Centers for Medicare and Medicaid {CMS} State Operational Manual {SOM} 483.25 Quality of Care F309).  A discussion with the resident and/or legal representative is needed to come to an understanding of the expectations for end-of-life medical care.

 

A "Full Code" designates that the resident wants all medical measures taken including cardiopulmonary resuscitation.   Limited Code Status indicates which lifesaving measures the resident has chosen to be taken.   

 

It is important for the facility to have an effective system to identify and honor a resident's code status choice, whether it is a "full code" or "DNR".   The facility needs to ensure someone offers and explains to the resident and/or legal representative their right to choose their code status.  This information should be documented in the resident's clinical record.  The facility needs to ensure they have an effective system to identify the resident's code status.  Often, in the time of an emergency, staff is unaware of the resident's code status and valuable time is lost trying to locate the resident's chart to obtain this information.  The facility needs to ensure the system they are using is easily accessible and allows staff to quickly obtain the resident's code status.

 

Remember to offer your residents the opportunity to choose their code status (SOM Interpretive guidelines Resident Rights 483.10 (b)(8) F156).  Document this information in the clinical record (SOM 483.75(1) Clinical Records F514).  Additionally, the facility needs to have an effective system to ensure this information is readily accessible to staff, especially in an emergency situation.