Management of Do Not Resuscitate Orders
It is the policy of the Board of Education that all students will be provided with immediate first aid and 911 emergency rescue services when a medical crisis and/or life threatening episode occurs at school. However, if the attending physician and parent/guardian of a student have executed a written "Do Not Resuscitate" order, school personnel will act in accordance with that order and refrain from medical interventions that are not consistent with that order.
Definition: DNR – Do Not Resuscitate
"Do Not Resuscitate" (DNR) orders are written medical directives that limit treatment or make an exception to standard emergency procedures in the case of an individual who respirations or heart have stopped functioning. In the case of a minor, the request is made by the parent/guardian. When the student becomes eighteen (18) years of age, the request must come from the student rather than the parent/guardian. The ultimate order or directive comes from a physician and is co-signed by the parent/guardian.
The DNR Order
- A physician's DNR order form must be co-signed by the parent/guardian prior to submission to the district. The school nurse will refer the DNR order to the district's Medical Advisor for review and implementation. A Planning and Placement Team ("PPT") or 504 accommodation meeting will be scheduled to implement the order.
- The written order for a DNR must be renewed in writing every six months. A DNR may be revoked at any time by a written request by the parent/guardian or student, if eighteen (18) years or over.
- The original DNR order must be filed in the student's cumulative health record. Its existence will be documented in the PPT or 504 summary.
- A parent/guardian with guidance from the student's physician must develop a transportation plan with the EMS System in the event that the school requests transportation. The school will use the 911 system, but will identify the student's DNR status.
- The Superintendent shall be notified when a school receives a DNR order.
Implementation of DNR Orders
- Upon receiving a DNR order, the school nurse will notify the Medical Advisor and schedule a PPT or 504 accommodation meeting. All proceedings are to be documented on the nurse's notes section of the student's cumulative health record.
- An individualized Health Care Plan ("IHCP") must be developed, identifying the DNR status and an emergency protocol to follow.
- The school nurse is responsible for ensuring that all staff members who are informed of the DNR order are trained to follow the expected procedure.
- Student confidentiality must be maintained to the extent desired by the parent/guardian. The parent/guardian must be advised that anyone who is not directly informed about the DNR order will otherwise follow Board of Education policy and initiate Cardiopulmonary Resuscitation ("CPR"). All CPR certified personnel in a school should be appraised of the DNR order.
- At the first signs of deteriorating health status, the student will be transported to the school health office. The school nurse will assess the student, contact the parent/guardian, and initiate the process for transporting the student to home/emergency room. NOTE: If the EMS System is initiated, the student is to be identified as having a DNR and the school should be prepared to provide a copy of the DNR paperwork to the EMS.
- Prior to the development of the IHCP, the school nurse shall consult with the parent/guardian to determine the procedure to follow in the event the student dies while at
School. The parent/guardian should designate the medical personnel to be contacted and should arrange for transportation to a designated location.
- The IHCP shall be reviewed monthly and revised as needed by the school nurse. Parents may review the IHCP at their request.
- Crises Intervention Teams should prepare for and be activated following the death of any student to assist the school community and family.
- The Medical Advisor and Superintendent should be notified within twenty-four (24) hours when a death occurs in school.
- Any school nurse or medical advisor who has an ethical, philosophical, or religious objection, to implementing a DNR order shall disclose the same during the PPT or 504
Implementation of DNR Orders (continued)
accommodation meeting. At such time, they shall turn over care of the student without delay to another school nurse, school nurse supervisor, school medical advisor or EMS personnel who will implement the DNR order, pending the assumption of care by another provider, the DNR order shall be followed.
Any questions or issues related to EMS responding to a school for a specific student with a DNR order may be directed to the Office of Emergency Medical Services, State Department of Public Health and Addiction Services.
Litchfield Board of Education
Policy Adopted: March 26, 1996
Policy Reviewed: October 1, 1998
Policy Reviewed by school nurses: November 2005
Policy Reviewed: January 18, 2006
Policy Rewritten: August 13, 2014