Do you use AND at your facility rather than DNR? If so please let me know what state and facility you work at. I am trying to institute this at our facility so it is important to know what other facilities are using this.
Thanks so much
Have never heard of this. Legally speaking, I would want the order to be specific as possible, example: "Do Not Recussitate, Do Not Intubate" (DNR/DNI). "Allow natural death" is too vague. Do they still want comfort measures? Any kind of medications? Because technically, ANY interventions we do in a hospital would go against what is "natural."
Many hospitals have adopted AND rather than DNR. When you are faced with making a decision on your loved one and you are aproached with the terminology DO NOT RESUSITATE unfortunately most only hear the words DO NOT no matter how much you explain. DNR also says nothing about comfort measures or medications, but when you start by approaching it with the words allow natural death it is a much easier transition to then talk about comfort measures and family or even the patients wishes.
Anyone without a SIGNED DNR gets a full code, trip to hospital, etc. Only way anyone gets a 'AND' (first I ever heard of this term was today) is by way of Hospice or DNR.
BTW, my facility (LTC) Admin had a talk with us a while ago; seems that, if we find someone in Resp. Distress, we are to give them comfort UNLESS otherwise stipulated in chart ie: DNR, other written out wishes.
Whatever happened to letting people go in peace, like in 'the old days'?
I had never heard of A.N.D until this discussion and after reading the posts as well as the webpage offered by MICU-RN, find the concept very compelling. We've all spent countless hours trying to clarify DNR/I terminology and from my perspective, wholeheartedly agree that the phrasing very often becomes the issue. While A.N.D will still require explanation, the message of the acronym is much more appealing than D.N.R. and D.N.I. I will bring this idea to our Palliative Care committee and recommend that we explore the possibility of changing our own terminology.
Many Thanks,
R
At my hospital, we use DNR/DNI. Far too rarely is the question of no code addressed. I also find that hospital doctors seem not to know how or when to introduce the family to the concept of comfort measures, nor do they know how to write orders for comfort care medication. When speaking to one young resident about the issue with one of my dying patients, she acknowledged that she's never willing to give up. I like this idea of AND, especially if it involves specific instructions.
dnightnurse wrote:At my hospital, we use DNR/DNI. Far too rarely is the question of no code addressed. I also find that hospital doctors seem not to know how or when to introduce the family to the concept of comfort measures, nor do they know how to write orders for comfort care medication. When speaking to one young resident about the issue with one of my dying patients, she acknowledged that she's never willing to give up. I like this idea of AND, especially if it involves specific instructions.
I agree- it's a great idea, BUT, like you said, there need to be specific instructions. Without specifics, there's just too much gray area.
I have D.N.R. tattooed on my chest in big red letters. this is the truth.
My wife hates it.
If that is what floats your boat and gets the point across, Tee! I would honor it.
Teeituptom wrote:I have D.N.R. tattooed on my chest in big red letters. this is the truth.
My wife hates it.
Love this! :) I was (jokingly) considering having "I refuse the foley" tattooed on my inner thigh! hehe....
AmandaWIRN wrote:Love this! :) I was (jokingly) considering having "I refuse the foley" tattooed on my inner thigh! hehe....
The trouble here is who I would let do the tattoo there. I would not want a guy to do it, and my wife would not want a woman to tattoo there either.
