DNR versus [P]MOLST

Posted on April 18, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

Of Differences and Distinctions

By Dr. David Edward Marcinko MBA

By Hope Rachel Hetico RN MHA

DNR Definition

A Do Not Resuscitate Order (DNR) is a refusal of cardiopulmonary resuscitation in the event of cardiac or pulmonary arrest.  A DNR, which is signed by a physician upon your consent, applies only if you are in a hospital or nursing home. If you are in your residence, a hospice, a clinic, or anywhere else and do not wish to be resuscitated, you must have a “Non-Hospital” DNR signed by your physician.

Sample form: http://www.ochealthinfo.com/docs/forms/ems_dnr_form.pdf

P-MOLST Definition

A P-MOLST (Physician – Medical Orders for Life-Sustaining Treatment) can be used to document your wishes concerning various forms of life-sustaining medical treatment, including DNR, endotracheal intubation and mechanical ventilation, artificial nutrition and hydration, future hospitalization, antibiotics, and other instructions. It is designed to improve the quality of end of life care for those with serious health conditions or those who wish to define their care wishes when facing the end of life. The form must be completed by both you and your physician. It is intended to apply immediately, and not upon a trigger of future incapacity. The form may be completed in stages as a medical condition deteriorates.

Sample form: http://www.compassionandsupport.org/pdfs/professionals/molst/DOH-5003_06.10_.FINAL__.pdf

Assessment 

Subsequent to the publication of the Institute of Medicine Report “Approaching Death: Improving Care at the End-of-Life”, the Rochester Individual Practice Association and BlueCross BlueShield Rochester Region End-of-Life/Palliative Care Professional Advisory Committee was formed to address these and related issues.

Link: http://www.compassionandsupport.org/index.php/about_us

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5 Responses

  1. Dr. David Marcinko MBA, on April 20, 2011 at 12:07 AM said:

    More on DNRs

    People with do-not-resuscitate (DNR) orders may be more than twice as likely to die soon after surgery, regardless of the urgency of the procedure or health status before surgery.

    http://www.webmd.com/news/20110418/dnr-orders-may-affect-surgical-outcomes

    A new study shows 23% of people with DNR orders died within 30 days after surgery compared with 8% of similarly matched surgery patients without DNR orders. They were also more likely to suffer serious complications and have longer hospital stays.

    http://archsurg.ama-assn.org/cgi/content/short/archsurg.2011.69

    Dr. David Edward Marcinko MBA
    [Publisher-in-Chief]

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  2. Dr. David Edward Marcinko MBA, on April 27, 2011 at 12:18 AM said:

    Appointment of Agent to Control Disposition of Remains

    In this form, you may designate who is in charge of the disposition of your remains after your death and state directions to the agent regarding the disposition.

    The agent is authorized to carry out your directions to the extent such directions are lawful and practical, and considering the financial capacity of your estate.

    This form is useful if your spouse or children are not your chosen agent in this regard or if you have a request you think may not be honored by those family members.

    Dr. David Edward Marcinko MBA

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  3. Hope R. Hetico RN MHA, on April 27, 2011 at 9:30 PM said:

    More on Advanced Directives

    http://www.kevinmd.com/blog/2011/04/advance-directive-part-life-decision-making.html#more-52434

    Hope R. Hetico RN MHA
    [Managing Editor]

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  4. Ann Miller RN MHA, on November 4, 2011 at 11:23 PM said:

    [Medical] Physician Orders for Life Sustaining Treatment M(POLST)

    Physician Helen Kao hates M-POLST forms even as she uses them daily. In this essay, she notes the importance of language and how it can hinder communication and decision making.

    http://www.geripal.org/2011/10/some-days-i-hate-polst.html

    Ann Miller RN MHA

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  5. Hope R. Hetico RN MHA, on May 22, 2014 at 11:22 AM said:

    Most Docs Prefer DNR For Themselves

    Researchers wanted to learn more about the attitudes of young doctors towards advance directives. So they asked what choices they would make for themselves if they were terminally ill.

    http://newoldage.blogs.nytimes.com/2014/05/20/do-not-resuscitate-what-young-doctors-would-choose/?_php=true&_type=blogs&_php=true&_type=blogs&_r=1&utm_source=Copy+of+5.20.14&utm_campaign=11713&utm_medium=email&

    Their reply: 88.3 percent of the docs would choose a do-not-resuscitate or “no code” status.

    Hope R. Hetico RN MHA

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