Question: I have recently received an ACR audit, and have spoken to others, within my service, who have received audits as well, stating that a DNR patient who has not arrested should be ventilated via BVM. Everyone is under the impression that a DNR patient should not be bagged. I know that I have had previous conversations with SWORBHP educators in which the final word on this subject had been no BVM in the presence of a DNR irregardless of whether then patient was VSA or pre-arrest. A similar question on this issue was previously asked and answered on 1-March-2012 with the resulting answer being "therefore, to answer your question, if a valid DNR form is available, none of these "advanced cardiopulmonary resuscitation" procedures should be initiated, period. The SWORBHP medical directors would suggest that this is independent of whether or not the patient has completely arrested or not". The question now is what is the right thing to do? What we have previously been told is right or what the auditors are now saying we should be doing? Could you please shed some light on the situation because there's once again a lot of confusion surrounding the correct application of the DNR. Thanks.

 Thanks for the question. Sorry that there is confusion. We have checked with our audit staff, and if we have the correct case in mind, we believe that it may be that our auditors missed during their review that the patient in question actually had a valid DNR form.

You are correct, the DNR standard clearly indicates that a paramedic will not insert an oropharyngeal or nasopharyngeal airway or perform artificial ventilation to any patient with a completed and valid DNR confirmation form. As such, the patient should not have been ventilated by a BVM.

For further information about the DNR confirmation form, please visit our website at: www.lhsc.on.ca/About_Us/Base_Hospital_Program/No.108V.1.0DNRStandard.pdf

DNR,Miscellaneous

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