With ("Do Not Resuscitate") DNR orders

1. The following forms will be FAXed to The Children’s Inn for patients who have been designated DNR:

• A completed DNR TCI Form Letter  (15 KB) signed by the Primary Care and Attending Physicians. 
• A hard copy of the DNR order printed out from MIS.
• Forms will be included in the resident’s TCI file.

2. Procedures to be followed by Clinical Center staff prior to a DNR referral to The Children's Inn.

3. Clinical Center staff will make a medical determination and review the appropriateness of a stay at The Children’s Inn for all DNR patients. Patients whose death is imminent, or whose terminal events are likely to require significant palliative support to allow death with dignity, will not be sent to The Inn.

4. If the status of a DNR Inn resident deteriorates such that transport back to the patient care uni is necessary for palliative medical management, only NIH Fire/EMS should be notified.

5. Activation of Montgomery County EMS should be avoided at all costs, as Montgomery County EMS cannot honor DNR orders executed at the NIH Clinical Center. County EMS workers are only authorized to honor Maryland EMS/DNR order forms that must be completed and signed by a physician licensed to practice in Maryland.

6. When a patient expires at The Inn, the patient’s care unit should be notified and NIH Fire/EMS should be contacted to transport the body back to the Clinical Center.

7. Clinical Center staff should notify The Children’s Inn if a patient with DNR orders will be coming to The Inn to participate in day activities.

This information is prepared specifically for caregivers involved in clinical research at the NIH Clinical Center at the National Institutes of Health.

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