New Jersey Administrative Code
Title 17 - TREASURY - GENERAL
Chapter 41 - OFFICE OF THE OMBUDSPERSON FOR THE INSTITUTIONALIZED ELDERLY PRACTICE AND PROCEDURE RULES
Subchapter 2 - PROCEDURES REQUIRED PRIOR TO WITHHOLDING OR WITHDRAWING LIFE-SUSTAINING TREATMENT FROM ELDERLY, INSTITUTIONALIZED RESIDENTS
Section 17:41-2.5 - Use of "Do Not Resuscitate" orders in facilities
Universal Citation: NJ Admin Code 17:41-2.5
Current through Register Vol. 56, No. 18, September 16, 2024
(a) "Do Not Resuscitate" orders ("DNRs") are orders written by a physician or advanced practice nurse in collaboration with a physician, which must be made part of the resident's medical record in the same way as any other order.
(b) DNRs can be appropriately utilized in a facility, provided the following safeguards are employed:
1. Prior to writing
a DNR, the attending physician or advanced practice nurse after consultation
with the attending physician shall:
i.
Discuss the circumstances surrounding his or her decision to enter such an
order with the resident, or if the resident is incapacitated, with the
resident's surrogate decision-maker or health care proxy, as
appropriate;
ii. If a resident has
a court appointed guardian, consult with that guardian before the DNR order is
written;
iii. If there is no
surrogate decision maker, designated proxy, or guardian, the physician or
advanced practice nurse shall exercise his or her best professional judgment
regarding the order, and may seek consultation with the Ombudsperson or a
regional long-term care ethics committee;
iv. Document the above-referenced
discussions; and
v. Document the
resident's medical history, diagnosis, prognosis as they relate to the
DNR.
2. The DNR shall be
clear and precise, and include appropriate plan of palliative care;
3. If the resident has the capacity to make
health care decisions, and requests that the attending physician or advanced
practice nurse place a DNR on his or her chart, the attending physician or
advanced practice nurse in collaboration with the attending physician shall
determine that the resident is fully informed, aware of his or her diagnosis
and prognosis, the risks, benefits and any alternatives, that this is in fact
the resident's wish, and that there is no coercion;
4. If a resident is transferred from an acute
care hospital to a facility, and a DNR had been written in the hospital, that
order shall be thoroughly reviewed and rewritten by the facility attending
physician or advanced practice nurse in collaboration with the facility
attending physician and in accordance with facility policy; and
5. If the resident has executed a DNR clause
as part of an Advance Directive, that clause shall not be effective as a DNR
order unless and until the attending physician or advanced practice nurse in
collaboration with the attending physician has followed (b)1 through 4 above,
and entered a DNR order in the resident's medical record.
(c) A resident, responsible family member, a health care proxy, or a surrogate decision-maker can initiate the request that the physician or advanced practice nurse write a DNR and enter it in the resident's medical record.
Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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