The Difference Between DNR and Comfort Care

Recently while on call a nurse called me from ACH. She stated that a Dr. So-and-so called in a particular dilating drop for a certain baby. She was only questioning the order because the baby had been made DNR (do not resuscitate) earlier that day. Firstly I told her that Dr. So-and-so was an outside eye doctor, so if he was calling in orders for a particular patient, they needed to call him, not me. Secondly I asked her what difference it made if the baby is DNR.

I don't think she really understood what DNR means and how it is VERY different from comfort care or hospice care. DNR is what is done when it isn't felt a person is well enough to survive resuscitative efforts, should they become required. DNR means simply this: if a patient enters cardiac or respiratory arrest, efforts are not to be made to restore those functions. Outside of one of these two occurrences, all possible care is to be provided. This includes any antibiotics, any minor procedures (major ones requiring intubation in the operating room require a temporary lift of the DNR order but are otherwise allowable), and basically any other medical treatment necessary for the patient's well being, even pressor support if need be. So if Dr. So-and-so wanted her to have dilating drops so that he may perform a good dilated exam the next day, this is perfectly acceptable.

Comfort care is very different. Comfort care should occur when there is absolutely no hope that a patient will get better, and will with 99% certainty die, typically very soon. I would say 100%, but you never can be 100% sure. At any rate, all medical treatment is stopped. The only treatments provided are those meant to keep the patient comfortable until the time of death, as implied by the name. Patients going into hospice care are generally in this category, though I once took care of a patient in the ICU who came from a hospice care facility with the family thinking she was there in substitute for a nursing home. Very different, but there was no convincing the family of that.

Oh, and don't ever tattoo "Do Not Resuscitate" on your body. If you have a witnessed cardiac arrest, and are otherwise kinda healthy, not even necessarily totally healthy, your chances of survival are high, and you've instead just bought yourself a death wish. Very, very stupid.