Guest guest Posted August 30, 2000 Report Share Posted August 30, 2000 , the reason why there are two seperate forms for the " in hospital " DNR and the Out Of Hospital DNR is because there are two different laws qoverning those situations. The hospital's forms generally are only recognized within the hospital, so the Out-of-Hospital DNR legislation was created to cover all those instances when the patient was not actually admitted in the hospital. Why do hospital staff or social workers not tell patients and families that the IH DNR form is only good within the hospital? Your guess is as good as mine. The Texas Dept of Health and the Texas Dept of Human Services have been working to get information concerning the differences between the IH DNR order and the OOH DNR order and recent changes to the OOH DNR to healthcare systems across Texas. Also, the current OOH DNR form can be downloaded from TDH's website at http://www.tdh.state.tx.us/hcqs/ems/emshome.htm for free or ordered from the Texas Medical Association (512/ 370-1306) for $0.22 per copy, assuming you want more than one copy. (One copy can be ordered for free by sending TMA a self-addressed stamped envelope.) The form doesn't come from the Health Dept, unless a local or county health department has ordered some to keep in their offices. [texasems-L] DNR OK, I have a question.....Why is it necessary to have separate DNR forms for " In Hospital " and " Out of Hospital " ? I had a patient the other day who was being moved to another facility for dialysis. She was unresponsive and breathing 8 times per minute, when she was breathing. She had long periods of apnea, from 45 seconds to 90 seconds. The patient's family had done all the required paperwork to execute an " In Hospital " DNR and believed that would work for the ambulance and the nursing home. As I explained to them that the document was not effective except in the hospital, they became very upset and asked if I had a form for them to fill out before the patient was moved. They were then told by the hospital that they could obtain one from the Health Department for $1.50. I am sure that there is a good reason somewhere as to why there are separate forms, but I have yet to find anyone who can tell me that reason. This is not the first time I have encountered this situation and it seems that the hospitals do not make it clear to families that the IH DNR can only be honored in the hospital. Most of the time, families believe that once they have executed the IH DNR, thatit will also be effective for EMS and Nursing homes. It seems reasonable to me that at the very least, hospital personnel should be obligated to explain to these folks that a separate form is required in any setting outside the hospital. I just think there should be a way for the DNR form to be standardized and that on one form, the option for OOH DNR could be combined with the IH DNR. I also think that anyone who assists a family in executing a DNR document, should be morally, if not leagally bound to explain to the family exactly what is covered and what is not! I am sure that others out there have encountered the same problem. What can be done about it and who do we need to address to do something about it? Neel, EMT-P Central EMS West Columbia, Texas Quote Link to comment Share on other sites More sharing options...
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