DNR one of area of conflict base on our background and believes, which reflect on our practice. By understanding DNR and its types may facilitate and enhance the MDT discussion to direct patients care and family support. DNR is a medical decision DNR not meant not to treat DNR is direction of health care base on the best available evidence and patient conditions DNR need opinion of the must expert seniors

1. Do Not Resuscitate (DNR) order.

3. agenda
INTRODUCTION
1
Definition
2
Do not resuscitate
3
DNR police in Saudi Arabia
4
Q&A
5

4. - CPR started by
Anesthesiologists in 1960s.
- DNR introduced by AHA in
1974 .

5. “If three knowledgeable physicians approve that the
patient's condition is desperate, it is not a must to
offer cardiac and respiratory support. The patient's
relatives are involved in the discussion of DNR.
However, the decision-making of DNR is purely a
medical decision as the patients and their relatives
are unprepared to make such decisions.”
The Islamic opinion on DNR was published in 1988

6. selecting visual aids
ENHANCING YOUR PRESENTATION

7. Definition
DNR AND RELATED TERMINOLOGY

8. • DNR
• In event of cardiac or cardiopulmonary deterioration or arrest,
resuscitation measures will not be initiated, including defibrillators/DC
shock and intubation
Forms of DNR:
• Withhold
• Refraining from starting cardiopulmonary resuscitative measures or
decline of starting life support measures
• Withdrawal
• in this document, refers to stopping cardiopulmonary resuscitative
measures or life support measures.
• Limited escalation
• clinical guidance setting out limit to appropriate treatment choices for
patients approaching the end of life, in the event they become acutely
unwell
8

9. 9
• Irreversible coma:
A coma or persistent vegetative state from which the person is not expected to
recover
• Persistent vegetative state:
A state in which a person has no awareness but may still have certain characteristics
that can simulate awareness, such as opening their eyes, having normal sleeping
and waking periods, sucking, chewing, coughing, gagging, and swallowing
• Terminally ill:
The medical state of being near death where there is no possibility of cure
• Life-sustaining treatment:
Any medical procedure, medication, or technology that can keep a person alive for
a period of time but that cannot cure a terminal condition
• Palliative care:
Specialized medical care that is focused on keeping a person free of pain and the
stresses of a serious illness, regardless of the diagnosis, and is aimed at improving
quality of life for both the person and family

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11. How is DNR order written?
• 3 Physicians should signing the forum one of them is the attending
physician
• discuss with the care givers/patients /surrogate decision maker.
•Conversation should be documented in patient's notes including the
nature of terminal life threatening illness including the direction of
care. And indicate who were present during the conversation.
•Nursing communicates DNR status during shift reports and verifies
by checking the medical record
•DNR valid for 1 years. If this signed by other facility it’s valid for 24h.

12. What if family disagrees with DNR order?
Conversation with family members in order to clarify the
benefits and risks of CPR and reasonable explanation in
most situation will help to resolve the issue.
If not, this should be referred to the Ethics
committee.

13. DNR is part of end of life care

14. DNR is a medical decision

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16. 16
https://www.moh.gov.sa/en/Ministry/MediaCenter/Publications/
Documents/National-Policy-and-Procedure-for-DNR-Status-EN.pdf

17. thank you