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, 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

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