PJ15 Do Not Resuscitate Orders (DNR)

Contents

Presentation of a Do Not Resuscitate Order to the District

In order for Albuquerque Public Schools to recognize a Do Not Resuscitate Order as legally binding and valid, the order must be presented to the Manager of Nursing Services, the school nurse and the school principal and must meet the following requirements:

1. An original of the health care provider’s Do Not Resuscitate order, the state Emergency Medical Services (EMS) Do Not Resuscitate form, and the Albuquerque Public Schools Do Not Resuscitate form.  These forms shall be completed by the physician and the parent(s) / legal guardian(s). All forms must be the original document; copies are not acceptable.
2. Upon turning eighteen (18) years of age, the student shall be required to grant Do Not Resuscitate authorization unless custody of the student has been legally awarded to a guardian.

Upon receipt of a Do Not Resuscitate order, the school principal and the licensed school nurse shall immediately initiate the following procedures:

1. The Albuquerque Public Schools Nursing Services manager and the superintendent, or his/her designee, shall be informed that a Do Not Resuscitate order was received
2. The Albuquerque Public Schools Nursing manager and the superintendent, or his/her designee, shall receive the licensed school nurse’s review, a copy of the Do Not Resuscitate order, and any identified concerns with the order
3. Upon receiving a Do Not Resuscitate order, a conference shall be arranged with the parent(s)/legal guardian(s), the local Emergency Medical Service providers and appropriate school staff and health providers to outline expectations and procedures.
4. A plan of care, which follows the health care provider’s orders, shall be developed and include goals, outcomes and delegation of care to be addressed in the student’s Individualized Healthcare Plan. The healthcare plan shall be written by the licensed school nurse, in collaboration with the parent(s)/ legal guardian(s), and shall to be reviewed and updated as needed at the beginning of each semester.  If the student receives special education services, the healthcare plan shall be reviewed as part of the student’s Individual Education Plan and/or 504 Plan, and updated as needed. All proceedings shall be documented in the student’s health record.
5. The health care provider’s order, Emergency Medical Services Do Not Resuscitate form and Albuquerque Public Schools Do Not Resuscitate form shall be documented on the student’s emergency contact card and submitted to the Albuquerque Public Schools Nursing Services manager.
6. Student confidentiality shall be maintained as much as possible. Only school staff with a legitimate need-to-know shall be informed of the Do Not Resuscitate order. The parent(s)/legal guardian(s) shall be advised that anyone who is not directly informed about the Do Not Resuscitate order shall otherwise follow Albuquerque Public Schools policy and procedural directives and initiate resuscitation.
7. The licensed school nurse/school nurse practitioner shall be responsible for ensuring that all staff members who are informed of the Do Not Resuscitate 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 Do Not Resuscitate order suffers a cardiac or respiratory arrest at school, the following shall be implemented:

1. Activate Emergency Medical Services.
2. Contact the parent(s)/legal guardian(s).
3. Isolate the student and maintain as normal an atmosphere as possible in the school or site.
4. Contact the health care provider who wrote the Do Not Resuscitate order.
5. If a student with a Do Not Resuscitate order dies while at school, the school principal or designee shall inform the Office of the Medical Investigator, superintendent, New Mexico Department of Health and the Albuquerque Public Schools Nursing Services manager as soon as possible. The body shall not be moved until authorized by the Office of the Medical Investigator.
6. Grief counseling resources for school employees may be obtained from the Employee Assistance Program; and for students, from the Health and Wellness Counseling Team.
7. When appropriate, the district Crisis Counseling Team may be activated to provide assistance at the school.

Revocation of a Do Not Resuscitate Order

A Do Not Resuscitate order may be revoked at any time by:

1. Physical destruction of the Do Not Resuscitate order form with the consent of the authorized decision-maker; or,
2. An oral statement by the authorized decision-maker to resuscitate.

Staff informed about the original Do Not Resuscitate order shall be informed of its revocation. Record of the revocation shall be made on the student’s health record.  The Albuquerque Public Schools Nursing Services manager shall be informed, in writing, of the revocation of the Do Not Resuscitate order.

• Administrative Position: Assistant Superintendent of School and Community Support
• Department Director: Director of Health and Wellness/Manager of Nursing Services

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