DNR validity
Question# 856
In relation to DNRs:
If both treatment option boxes are checked, does that invalidate the DNR?
If both treatment option boxes are checked, does that invalidate the DNR?
Answer:
If both treatment option boxes are checked on a DNR, it can create some confusion as to what treatment the patient wants; therefore, the uncertainty in treatment renders the official Ministry of Health DNR form unclear.
To support paramedics, RPPEO released a Medical Advisory in 2023 that suggests patching to a BHP to consult on the appropriateness of terminating or withholding resuscitation. MA-2023-03 speaks to the need to respect a patient's wishes about treatment decisions when it comes to resuscitation consistent with the Healthcare Consent Act. The Medical Advisory was further converted to a standing policy which can be located here.
The ALS PCS Consent to Treatment Standard and the Health Care Consent Act, 1996, S.O. 1996, c. 2, Sched. A allows paramedics to apply clinical judgment and make patient-centered decisions about treatment at the scene of cardiac arrests, specifically where the patient’s wishes to withhold resuscitation are known. This includes verbal expression from a substitute decision maker of the patient’s wishes, or written DNR form other than the Ministry of Health DNR Confirmation Form. To address this issue, RPPEO has proposed changes to the BLS DNR standard, which is currently under review with the Ministry of Health and should be updated in 2025.
Furthermore, Associate Medical Director, Dr. Mark Froats prepared a video message about acceptance of verbal or written DNR requests.
To support paramedics, RPPEO released a Medical Advisory in 2023 that suggests patching to a BHP to consult on the appropriateness of terminating or withholding resuscitation. MA-2023-03 speaks to the need to respect a patient's wishes about treatment decisions when it comes to resuscitation consistent with the Healthcare Consent Act. The Medical Advisory was further converted to a standing policy which can be located here.
The ALS PCS Consent to Treatment Standard and the Health Care Consent Act, 1996, S.O. 1996, c. 2, Sched. A allows paramedics to apply clinical judgment and make patient-centered decisions about treatment at the scene of cardiac arrests, specifically where the patient’s wishes to withhold resuscitation are known. This includes verbal expression from a substitute decision maker of the patient’s wishes, or written DNR form other than the Ministry of Health DNR Confirmation Form. To address this issue, RPPEO has proposed changes to the BLS DNR standard, which is currently under review with the Ministry of Health and should be updated in 2025.
Furthermore, Associate Medical Director, Dr. Mark Froats prepared a video message about acceptance of verbal or written DNR requests.
References
MedicNEWS article: https://sway.cloud.microsoft/ptxvmiuWDN9bwIFy
Video-Dr.Froats: https://rppeo.wistia.com/medias/oa5qjrazhu
Clinical Policy: https://www.rppeo.ca/policies-practices/rppeo-policies?folder=Clinical
Video-Dr.Froats: https://rppeo.wistia.com/medias/oa5qjrazhu
Clinical Policy: https://www.rppeo.ca/policies-practices/rppeo-policies?folder=Clinical