14-191 C.M.R. ch. 3, § VI - ENTRY AND NOTICE OF DNR ORDER

The attending physician shall ensure that all DNR orders are written, signed, dated and entered into the medical record of the patient. At the time a DNR order is written, a companion entry should be made in the progress notes which includes at least: the diagnosis, prognosis of the patient, the patient's known wishes, the wishes of the patient's surrogate and the recommendations of named members of the treatment team. There should also be documentation supporting the finding of competency or incapacity of the patient and the written consent of the patient or his surrogate. No verbal or telephone orders to forego resuscitation shall be made. The DNR status of the patient shall be prominently noted or displayed at all times for the benefit of staff.

If a DNR order is discontinued due to a change in the patient's medical condition, the attending physician shall ensure that a dated and signed order to cancel and an explanatory note shall be written in the record. He shall also ensure that the patient, if possible, or his surrogate is informed of the rescission of the order. A new attending physician shall conduct his own review of the patient's condition and shall write his own order based on this review. If be believes that the existing DNR order should be discontinued for reasons other than a recent change in the patient's condition, he shall initiate the procedure for resolution of staff disagreement. If a decision is made to discontinue the DNR order, the procedures for discontinuance as outlined above shall be observed.

Notes

14-191 C.M.R. ch. 3, § VI