N.J. Admin. Code § 17:41-2.5 - Use of "Do Not Resuscitate" orders in facilities

(a) "Do Not Resuscitate" orders ("DNRs") are orders written by a physician or advanced practice nurse in collaboration with a physician, which must be made part of the resident's medical record in the same way as any other order.

(b) DNRs can be appropriately utilized in a facility, provided the following safeguards are employed:

1. Prior to writing a DNR, the attending physician or advanced practice nurse after consultation with the attending physician shall:

i. Discuss the circumstances surrounding his or her decision to enter such an order with the resident, or if the resident is incapacitated, with the resident's surrogate decision-maker or health care proxy, as appropriate;

ii. If a resident has a court appointed guardian, consult with that guardian before the DNR order is written;

iii. If there is no surrogate decision maker, designated proxy, or guardian, the physician or advanced practice nurse shall exercise his or her best professional judgment regarding the order, and may seek consultation with the Ombudsperson or a regional long-term care ethics committee;

iv. Document the above-referenced discussions; and

v. Document the resident's medical history, diagnosis, prognosis as they relate to the DNR.

2. The DNR shall be clear and precise, and include appropriate plan of palliative care;

3. If the resident has the capacity to make health care decisions, and requests that the attending physician or advanced practice nurse place a DNR on his or her chart, the attending physician or advanced practice nurse in collaboration with the attending physician shall determine that the resident is fully informed, aware of his or her diagnosis and prognosis, the risks, benefits and any alternatives, that this is in fact the resident's wish, and that there is no coercion;

4. If a resident is transferred from an acute care hospital to a facility, and a DNR had been written in the hospital, that order shall be thoroughly reviewed and rewritten by the facility attending physician or advanced practice nurse in collaboration with the facility attending physician and in accordance with facility policy; and

5. If the resident has executed a DNR clause as part of an Advance Directive, that clause shall not be effective as a DNR order unless and until the attending physician or advanced practice nurse in collaboration with the attending physician has followed (b)1 through 4 above, and entered a DNR order in the resident's medical record.

(c) A resident, responsible family member, a health care proxy, or a surrogate decision-maker can initiate the request that the physician or advanced practice nurse write a DNR and enter it in the resident's medical record.

Notes

N.J. Admin. Code § 17:41-2.5

Recodified from N.J.A.C. 8:90-2.5 and amended by R.2007 d.366, effective 12/3/2007.
See: 39 N.J.R. 2219(a), 39 N.J.R. 5101(a).
Added (b)1iii; recodified former (b)1iii and (b)1iv as (b)1iv and (b)1v; and in (b)4, inserted "and in accordance with facility policy".