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  • 1.  Ambulatory Code Blue and DNR status

    Posted 02-11-2025 18:58

    I come from longtime experience with inpatient care where we validated code status at each inpatient visit. Now I am working on an ambulatory code blue policy and a legality question came up for me and Im wondering if anyone already dug into this rabbit hole? 

     DNR status as listed in the patient's electronic health record and how we would handle a code blue in the clinic.

    • If a patient has a DNR status in the electronic health record that was verified during some prior stay in the hospital, does that cover us in the clinic if the patient coded?
    • If we haven't had a discussion with the patient to confirm that DNR status on the date of the clinic visit, do we follow the pre-existing DNR status or treat as full code? 
    • Or in the ambulatory space would we need to follow a POLST form similar to EMS? 

    I am curious what everyone's experience is on this. 

    Thank you! 



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    Kristie Hills
    Clinical Nurse Specialist
    Pulse Heart Institute
    Spokane WA
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  • 2.  RE: Ambulatory Code Blue and DNR status

    Posted 02-13-2025 11:20
    Edited by Kristin Kissell 02-13-2025 11:20

    This topic was recently brought to my attention and I am looking for some answers, too. Any information that others can share would be appreciated! 

    Thank you!



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    Kristin Kissell

    Clinical Resource Nurse Educator
    Penn State Health
    Hershey, PA
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    Original Message


  • 3.  RE: Ambulatory Code Blue and DNR status

    Posted 02-14-2025 07:38
    The answer may depend on whether you are physically attached to a larger acute care facility or are free-standing clinic. Where I am, we do not engage in extensive DNR or code blue practices. We are a specialty clinic (PM&R).  We have had patients "go down." We have an AED in the facility to begin C-P-R and we call 9-1-1. We do not have the equipment of staff to handle delays in getting the patient to acute care for treatment.

    If the patient has a POLST, it is typically on record with the PCP or the local hospital where the patient will be taken.  It has not been made available to the ambulatory care practices with the EMR (EPIC) where I work. 

    -mobley

    ---------------

     

    Aleesa M Mobley PhD APN  (she/her/hers) Why Pronouns Matter

    Assistant Professor - Clerkship Director [Pain Management/Substance Use Disorder]

    Physical Medicine & Rehabilitation - Neuro Musculoskeletal Institute 

    Lippincott Procedures: Subject Matter Expert - Wolters Kluwer Publishing


    Rowan Medicine Bldg., 42 E. Laurel Rd, Ste 1700, Stratford New Jersey 08084 

    T: 856-566-7010 | F: 856-566-6956| C: 856-230-1229 

    mobley@rowan.edu | som.rowan.edu 
    Learning is not attained by chance, it must be sought for with ardor and attended to with diligence [Abigail Adams (1744 - 1818), 1780].



    Original Message


  • 4.  RE: Ambulatory Code Blue and DNR status

    Posted 02-14-2025 09:47
    Edited by Valerie Younce 02-14-2025 09:47

    I am in Texas, and the DNR that is recognized in our clinics is the Out of Hospital DNR Order: Texas OUT-OF-HOSPITAL DO-NOT-RESUSCITATE (OOH-DNR) ORDER.

    If a patient has a DNR status from a prior inpatient stay, it does not automatically transfer to the outpatient setting and an OOH-DNR would need to be completed. 



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    Valerie Younce MSN, RN, AMB-BC
    Baylor Scott & White Health
    Temple TX
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    Original Message


  • 5.  RE: Ambulatory Code Blue and DNR status

    Posted 02-17-2025 09:50

    Valerie, 

        Thank you so much for this information! Can I ask how staff know if a patient has an OOH-DNR? Does an alert populate the EMR, or is it located somewhere in the patient's chart? 

    Thank you! 



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    Kristin Kissell RN
    Penn State Health
    Hershey PA
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    Original Message


  • 6.  RE: Ambulatory Code Blue and DNR status

    Posted 02-17-2025 11:11

    You are very welcome! We use Epic as our EMR system. The OOH-DNR status is in the patient's storyboard under the advanced care planning (ACP) section.  Staff can simply hover over the ACP to see if an OOH-DNR is on file.  We train staff to check this information when rooming a patient to ensure they are aware of the patient's code status. 



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    Valerie Younce, MSN, RN, AMB-BC
    Nursing Professional Development Specialist, RN
    Baylor Scott & White Health
    Temple, TX
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    Original Message


  • 7.  RE: Ambulatory Code Blue and DNR status

    Posted 02-17-2025 12:10

    That is great Valerie. I love that they check it during rooming. We have a little work to do here in my neck of the woods. 



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    Kristie Hills
    Clinical Nurse Specialist
    Spokane WA
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    Original Message


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