Where does one get one of these forms? I know people with DNRs and advance directives who live @ home.
I suspect some may not have heard of the DNR-CF, or believe it is necessary.
Perhaps they could be shown this from THE ONTARIO COLLEGE OF FAMILY PHYSICIANS:http://ocfp.on.ca/docs/communications/january-21-2008.pdf?sfvrsn=4
Do Not Resuscitate Confirmation Form
Recently, paramedics and firefighters have been authorized to honor the “Do Not Resuscitate” (DNR) orders of a patient. I would like to make certain that you are aware of the new form, The Do Not Resuscitate (DNR) Confirmation Form which will be the only form accepted in Ontario for this purpose as of February 1, 2008.
Like many of you, I care for patients at the end of life who wish to die in their own homes. A DNR order is appropriately obtained, documented and well known by all healthcare providers, caregivers and family involved. On occasion, for various reasons, 911 is called and paramedics and firefighters are required to attend the patient’s home to offer emergency assistance and/or transport the patient to hospital for further care. Currently paramedics are legally obliged under the Ambulance Act’s Basic Life Support Patient Care Standards, Version 2, to initiate life support measures (chest compression, defibrillation, artificial ventilation, insertion of an airway, endotracheal intubation, transcutaneous pacing or advanced resuscitation medications) to all patients irrespective of their personal directives or any current institutional DNR order. As you can well imagine, inappropriate resuscitative procedures often ensure contrary to the patient’s, family’s and physician’s wishes and orders. This often leads to significant detrimental consequences for the patient and family and is inappropriate use of limited human and financial resources.
To address this issue, and to ensure that a standardized process that allows paramedics and firefighters to honor the DNR wishes of patients, a DNR Task Force was convened in September 2003. Its efforts have resulted in the new The Do Not Resuscitate Confirmation Form, which will become the new standard of care in Ontario as of February 1, 2008. When this form has been completed by a physician or nurse (RPN, RN, RN (EC), paramedics and firefighters will now be authorized to withhold life support measures (as defined above). In addition, they will now be authorized to provide comfort (palliative) care as appropriate (oropharyngeal suctioning, O2, nitroglycerin, salbutamol, glucagon, epinephrine, opiods, ASA or benziodiazepines).
To access the enclosed form DNR Confirmation Form, go to the Government of Ontario website:http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/AttachDocsPublish/014-4519-45~
It can be ordered by going:http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=RDR&TAB=PROFILE&ENV=WWE&NO=014-4519-45
More specific information and details regarding the form and its use can be obtained in the following Ontario Medical Review article:
Verbeek PR, Sherwood C. End-of-life care in the home: How a new procedure for Ontario paramedics and firefighters may affect your patients and your practice. Ontario Medical Review 2007 November; Vol 74 (10):39-42. Please go to: https://www.oma.org/pcomm/OMR/nov/07maintoc.htm
Family physicians will play a pivotal role in the successful implementation of this new standard. It is up to those of us who provide care at home to patients at the end of life who must now make concerted efforts to ensure that this new process will honor our patients’ wishes and prevent the untoward consequences which occur too often despite our best intentions.
Sandy Buchman MD CCFP FCFP
The Ontario College of Family Physicians