DNR and AHCD

[powerdef]

I am currently in an academy right now and during our inspection I was asked this question.

If you have an AHCD and a DNR and the DNR was dated more recent which would you honor? My answer was the AHCD because it is a more powerful document and he said I was wrong.


I have looked up this question in multiple places and have not found any definitive answer. Any opinions?

 

[Handsome Robb]

Depends on your state and agency protocols.

We can't honor AHCDs where I work, only a state issued DNR. In the setting of an IFT we can honor any DNR order signed by a physician. With anything else such as a living will or AHCD we have to start BLS and make OLMD contact for termination orders.

 

[Mavrande]

An AHCD can be much broader than a simple DNR order. Assuming both documents are still legally valid (the patient has not overridden or destroyed one of them) then both documents are still legally valid. Where there is a conflict, the one signed more recently has effect. If the AHCD declares a proxy, the proxy can still act as a proxy, but may not be able to overrule the DNR - although if they tried to and you worked it in the field then I doubt anyone would sue you. NJ's protocols state that you can honor a DNR that is presented to you or a revocation of that order by a proxy.

 

[Melclin]

Isn't there any "in good faith" type legislation where you are?

You know, that you talk to the pt/the pt's family, take into account the pt's age, co-morbidities, quality of life etc and then make a judgement in good faith about what the pt would want/what is best for the pt.

Eg. Hopped in the back with a palliative CA pt with some nasty SOB the other day and said, "Now, if anything happens and you get worse, become unconscious or your heart stops beating, do you want me to do anything about it?" She said, "Nothing at all".

Good enough for me.

 

[Aidey]

Most of us are in the US, do you really think it is that easy?

 

[Melclin]

Is someone really ganna sue you because you didn't attempt a resuscitation of a 94YO dementia pt with a normal GCS of 10, multiple co-morbidities who arrested in your care and you misinterpreted some legal documents that you thought in good faith stated the obvious and said don't resus?

Perhaps its silly question given the point you made

 

[usalsfyre]

Is someone really ganna sue you because you didn't attempt a resuscitation of a 94YO dementia pt with a normal GCS of 10, multiple co-morbidities who arrested in your care and you misinterpreted some legal documents that you thought in good faith stated the obvious and said don't resus?

Perhaps its silly question given the point you made

Actually....I can see it happening when Grandma is the social security meal ticket.

 

[usalsfyre]

Is anyone else concerned he's in "academy" and this came up in "inspection"? Since even the military doesn't educate physicians boot camp style?

 

[Handsome Robb]

Is anyone else concerned he's in "academy" and this came up in "inspection"? Since even the military doesn't educate physicians boot camp style?

I wondered about that. My guess is ore academy but it could also be an EMS Academy like some CA colleges run.

 

[mycrofft]

He's a MD?

If not, then a fire academy?
Darn right DoD doesn't treat MD's like new recruits, they would all quit and tell their friends.

A witnessed utterance while of sound mind and not under duress can decide if what you do is care, or assault and battery. Documents be damned.