Do Not Resuscitate Orders (DNR) - October 2009 Revision

This procedural directive was reviewed and revised in November 2010. We provide this revision for historic purposes only.

Presentation of a Do Not Resuscitate Order to the District

When a Do Not Resuscitate Order (DNR) for a student is to be presented to the District, the following criteria must be met:

1. An original of the physician’s order, the state Emergency Medical Services (EMS) Do Not Resuscitate form, and the APS Do Not Resuscitate form must be completed by the physician and the parent(s) / legal guardian(s) and submitted to the school. Copies are not acceptable.
2. When a student is 18 years of age, the DNR authorization must be made by the student, unless custody of the student has been legally awarded to a guardian.

A DNR order is to be presented to the school principal and the licensed school nurse, who will initiate the following procedures:

1. The District Nursing Coordinator and the Superintendent designee are to be informed when the school has received a DNR order, and the school should also submit the licensed school nurse’s review, a copy of the DNR order, and any identified concerns with the order.
2. Upon receiving a DNR order, a conference will be arranged with the parent(s)/guardian(s), the local EMS providers and appropriate school staff and health providers to outline expectations and procedures. A plan of care, which follows the physician’s orders, will be developed and include goals, outcomes and delegation of care to be addressed in the student’s Individualized Healthcare Plan. The healthcare plan will be written by the licensed school nurse, in collaboration with the parent(s)/ guardian(s), and is to be reviewed at the beginning of each semester and as part of each IEP and/or 504 plan, and updated as needed. All proceedings are to be documented in the student’s health record.
3. The physician’s order, EMS DNR form and APS DNR form must be documented on the student’s Emergency Card and submitted to the District Nursing Coordinator. DNR orders are to be reviewed at the beginning of each semester and as part of each IEP or 504 plan. 
4. Student confidentiality will be maintained as much as possible. Only school staff with a legitimate need-to-know will be informed of the DNR order. The parent(s)/guardian(s) will be advised that anyone who is not directly informed about the DNR order will otherwise follow APS policy and initiate resuscitation.
5. The licensed school nurse will be responsible for ensuring that all staff members who are informed of the DNR order are trained to follow the expected procedures as delineated in the student’s healthcare plan.

Procedures for Implementing a Do Not Resuscitate Order

If a student with a DNR order suffers a cardiac or respiratory arrest at school, the following will be implemented:

1. Activate Emergency Medical Services.
2. Contact the parent(s)/guardian(s).
3. Isolate the student and maintain as normal an atmosphere as possible in the school or site.
4. Contact the physician who wrote the DNR order.
5. If a student with a DNR order dies while at school, the school principal or designee will inform the Office of the Medical Investigator, Superintendent and the District Nursing Coordinator as soon as possible. The body may not be moved until authorized by the Office of the Medical Investigator.
6. Grief counseling resources for school employees can be obtained from the Employee Assistance Program; and for students, from the Student support Services Non-crisis Counseling Team.
7. When appropriate, the District Crisis Counseling Team will be activated to provide assistance at the school.

Revocation of a Do Not Resuscitate Order

The DNR order may be revoked at any time by:

1. Physical destruction of the DNR Order form with the consent of the authorized decision-maker; or,
2. an oral statement by the authorized decision-maker to resuscitate.

Staff who have been informed about the original DNR order will be informed of its revocation. Record of the revocation will be made on the student’s health record. 

NSBA/NEPN Classification: JFABC

Cross Ref.: Board Policy J.29

Approved: November 18, 1999

This page was last updated on: December 9, 2009.