Before referring a child with a DNR order to The Children’s Inn

1. Patient must be registered in the Clinical Center, given a patient number, and admitted to an inpatient unit.

2. A DNR order is completed by the appropriate medical team and entered into the MIS and patient chart after full discussion with the parent(s) or legal guardian(s) having the power to consent to a DNR order. Unless a parent/guardian has sole custody, discussion of the DNR order should be with both parents/guardians. [Note: Legal guardians generally do not have the authority to consent to a DNR order without court approval].

3. A review of what would happen at TCI, if such an event should occur with a DNR order in place, must take place with the family. This review will be done by a physician or any other member of the health care team. This should be documented in the patient’s Medical Record, and the manager on duty at TCI should be notified that such a meeting occurred.

4. A bed needs to be assigned for the patient on one of the patient care units. Then the patient can be placed “on-pass” prior to going to the Inn.

5. A phone call to the Manager on Duty (301-496-5672) must be made once the DNR order is in place and before the child either comes to the Inn for the first time or returns to the Inn. This call can be made by a member of the medical team or the social worker.

6. Once the standardized letter had been signed, please give a copy to the parent(s).

7. The standardized letter and DNR order, as it appears in the MIS, must then be faxed to TCI (301-496-4421).

8. A copy of the DNR letter is to be given to the family/patient. Ask them to carry the letter with them.

9. The staff at TCI will follow a checklist at the TCI to ensure that all paperwork was received.

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