Allow natural death

[dixie816]

Do you use AND at your facility rather than DNR? If so please let me know what state and facility you work at. I am trying to institute this at our facility so it is important to know what other facilities are using this.
Thanks so much

[AmandaWIRN]

Have never heard of this. Legally speaking, I would want the order to be specific as possible, example: "Do Not Recussitate, Do Not Intubate" (DNR/DNI). "Allow natural death" is too vague. Do they still want comfort measures? Any kind of medications? Because technically, ANY interventions we do in a hospital would go against what is "natural."

[dixie816]

Many hospitals have adopted AND rather than DNR. When you are faced with making a decision on your loved one and you are aproached with the terminology DO NOT RESUSITATE unfortunately most only hear the words DO NOT no matter how much you explain. DNR also says nothing about comfort measures or medications, but when you start by approaching it with the words allow natural death it is a much easier transition to then talk about comfort measures and family or even the patients wishes.

[cougarnurse]

Anyone without a SIGNED DNR gets a full code, trip to hospital, etc. Only way anyone gets a 'AND' (first I ever heard of this term was today) is by way of Hospice or DNR.

BTW, my facility (LTC) Admin had a talk with us a while ago; seems that, if we find someone in Resp. Distress, we are to give them comfort UNLESS otherwise stipulated in chart ie: DNR, other written out wishes.

Whatever happened to letting people go in peace, like in 'the old days'?

[MICU-RN]

Out of curiosity, I did a search and came up with the link below on "Allow Natural Death"

Alternative to "DNR" Designation: "Allow Natural Death" - Making Sense in the Health Care Industry

[Ricu]

I had never heard of A.N.D until this discussion and after reading the posts as well as the webpage offered by MICU-RN, find the concept very compelling. We've all spent countless hours trying to clarify DNR/I terminology and from my perspective, wholeheartedly agree that the phrasing very often becomes the issue. While A.N.D will still require explanation, the message of the acronym is much more appealing than D.N.R. and D.N.I. I will bring this idea to our Palliative Care committee and recommend that we explore the possibility of changing our own terminology.

Many Thanks,

R

[SoldierNurse]

Originally Posted by MICU-RN

Out of curiosity, I did a search and came up with the link below on "Allow Natural Death"

Alternative to "DNR" Designation: "Allow Natural Death" - Making Sense in the Health Care Industry

Thanks for the link!

"When questioned about how AND would be defined, Rev. Meyer has written:

There are a couple of ways to implement the AND designation. In facilities where there are only two codes, Full Code and DNR, we could change the DNR to AND. In Austin, as in other cities, we have three codes: Full Support, Intermediate Support and Comfort Support. At our Round Rock facility we have changed the second category to INTERMEDIATE SUPPORT - ALLOW NATURAL DEATH. With this, medical procedures may be continued (vent, IV's, artificial nutrition/hydration)to see if the patient can be nudged through the illness. But if not, we ALLOW NATURAL DEATH (without coding.) Category III is called COMFORT SUPPORT - ALLOW NATURAL DEATH. Here comfort is the primary goal, and all care is aimed at that goal."

Sounds like a great idea, IMHO.

[SoldierNurse]

Originally Posted by AmandaWIRN

Have never heard of this. Legally speaking, I would want the order to be specific as possible, example: "Do Not Recussitate, Do Not Intubate" (DNR/DNI). "Allow natural death" is too vague. Do they still want comfort measures? Any kind of medications? Because technically, ANY interventions we do in a hospital would go against what is "natural."

AND Explanation

[dnightnurse]

At my hospital, we use DNR/DNI. Far too rarely is the question of no code addressed. I also find that hospital doctors seem not to know how or when to introduce the family to the concept of comfort measures, nor do they know how to write orders for comfort care medication. When speaking to one young resident about the issue with one of my dying patients, she acknowledged that she's never willing to give up. I like this idea of AND, especially if it involves specific instructions.

[AmandaWIRN]

Originally Posted by dnightnurse

At my hospital, we use DNR/DNI. Far too rarely is the question of no code addressed. I also find that hospital doctors seem not to know how or when to introduce the family to the concept of comfort measures, nor do they know how to write orders for comfort care medication. When speaking to one young resident about the issue with one of my dying patients, she acknowledged that she's never willing to give up. I like this idea of AND, especially if it involves specific instructions.

I agree- it's a great idea, BUT, like you said, there need to be specific instructions. Without specifics, there's just too much gray area.