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QUESTION: We are reviewing our policy regarding Direct Support Professionals providing CPR when an individual has a Do Not Resuscitate in place. Would others be willing to share their Policies on Do Not Resuscitate for individuals in group homes and/or waiver residential? Per ISDH: Direct support staff must do CPR until a medical professional intervenes. That includes folks who have a DNR order. The rationale is that the direct support staff should not be making medical decisions. Policy 1: Direct care staff are taught emergency medical interventions of CPR and First Aid. These interventions will be given to all clients when the situation calls for such a response. If the client or guardian has documented a desire for "no resuscitation," staff will aid the client in any way possible until a doctor can diagnose the problem and choose appropriate action to be taken. It is the client's or guardian's responsibility to express to the doctor or hospital personnel his/her desire for no resuscitation. The client's doctor, along with the guardian, can then make a decision about resuscitation while the client is hospitalized. When a client is in a facility, emergency interventions will be done as the staff have been trained. Procedure: 1. If a client becomes unconscious 911 will be immediately called unless: a. the person is suffering a seizure, or another identified medical condition that may cause a temporary loss of consciousness and b. it is known that 911 does not need to be called. 2. If a client ceases to breath and has a pulse, mouth to mouth breathing will be commenced and maintained until the client begins to breath or emergency personnel arrive at the facility. 3. If a client ceases to breath and has no pulse, CPR will be initiated until emergency personnel arrive or a pulse is felt - the client's heart starts beating. 4. If any client is choking or the person's airway is obstructed, abdominal thrusts or chest compressions will be performed. 5. First aid measures for severe bleeding, burns, fractures, heat emergencies, ear and eye injuries, shock etc. will be followed until emergency personnel can arrive at the home or day programming. 6. Poison Control will be called when a suspected poisoning has occurred. Policy 2: In situations where an individual has a legal, signed DO NOT RESUSCITATE(DNR) order, the group home provider should honor the individual’s DNR. In many instances, a DNR order will be in place because of the diagnosis of a terminal illness. At other times, the individual or family members may choose to have a DNR order in place due to their wishes or beliefs for end of life care. It is important for all staff to understand the wishes of the individual or family in regards to the DNR order. Most often, the decision for the order will be to allow a natural death due to the disease process. This would mean that in other circumstances, such as a person choking, that life giving processes (Heimlich) WOULD BE GIVEN. In cases where an individual has a DNR order in place, individual instructions will be written up and staff trained in those choices. This information is a compilation of suggestions, ideas, and opinions shared by INARF Members in response to the featured question. This information should not be considered official interpretation or guidance of State or Federal Policy. Additionally, statements within this document do not necessarily reflect an official position or opinion of INARF.
QUESTION: We are reviewing our policy regarding Direct Support Professionals providing CPR when an individual has a Do Not Resuscitate in place. Would others be willing to share their Policies on Do Not Resuscitate for individuals in group homes and/or waiver residential?