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Quick Tip for Families in Intensive Care: How to Reverse the DNR (Do Not Resuscitate) or NFR (Not for Resuscitation) in Intensive Care?

How to reverse the DNR (Do Not Resuscitate) or NFR (Not for Resuscitation) in intensive care. That’s what we’re going to discuss today.

My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.

If I had a dollar for every family that approached us over the years here at intensivecarehotline.com that said, “Oh, my family member has a DNR or an NFR in ICU, and we don’t know anything about it, we just found out and we want to reverse it”, I would be a very wealthy man, because there are so many families in intensive care that encounter this life or death issue.

On a bigger scheme on the grand scale, I’ve been blogging about this and in my videos, talking about it for, since 2013, that ICUs all around the world issue DNRs or NFRs, DNR stands for do not resuscitate, NFR stands, not for resuscitation, most of the time, I argue illegally without patient or family consent, and there are ways to revoke that because we have helped so many families over the years to revoke that DNR, there’s case studies on our website, there’s testimonials on our website, there’s even interviews on our website, and our podcast section at intensivecarehotline.com, how we’ve helped, literally within less than 24 hours to revoke the DNR or an NFR.

So, let’s break it down step by step. Reversing a ‘Do Not Resuscitate’ order in ICU is possible, but it must be done with clear communication, a little bit of legal understanding, and documented consent. Here’s how to approach it step by step.

Number one, identify who has the legal authority. If the patient is conscious, which most patients in ICU are not, mentally competent and able to communicate, they can revoke their own DNR at any time.

Next, healthcare proxy power of attorney. If the patient is incapacitated, the appointed legal decision maker by an advanced directive or medical power of attorney has the right to reverse the DNR or NFR.

Family. If no power of attorney is assigned and no advance directive exists, family members, usually in a legal hierarchy, may be able to request the change depending on state or country laws.

To break this down even further, most ICUs, especially when patients are incapacitated or, unconscious, ICUs want you as a family to make decisions. They want you to sign off on procedures, on diagnostics, etc, keep this in mind, how can you as a family member, sign off on, surgery, on diagnostics, on medical procedures that could be life or death decisions without you also being able to reverse the DNR?

There’s a lot of arguments to be made around that, that you can’t really sign off on anything, unless you are also able to reverse a DNR or an NFR. Take that angle and you will actually see that it works.

Next. Notify the ICU medical team immediately. Request an urgent meeting with ICU teams or ICU doctors, intensivists, nurses, and possibly hospital executive. Escalate it as quickly as possible. Clearly state your intention to reverse or revoke the DNR.

If they’re not responsive, escalate it to hospital executive pretty quickly, because that’s what we have done many times with our consulting and advocacy, escalated it to hospital executive with very good results because they know that they’re in breach of laws, breach of ethics.

There’s also an argument to be made, should it be escalated to a hospital ethics team? I have my reservations with hospital ethics team because they are not independent, they are hospital employees, and they will do whatever is in the best interest of the hospital, not what’s in the best interest of your family member.

That’s just my experience, and I would shy away from that, unless the hospital can prove to you that the ethics committee is 100% independent and has no affiliations with the hospital, and they’re not a hospital employee. And their careers and their future career prospects are not dependent on what they say on an ethics committee.

Next, update medical records. The revocation of a DNR or an NFR must be documented in writing and entered into the patient’s medical chart. A new code status order should be written by the attending physician to reflect the change, i.e. from DNR or NFR to full code or any other limitations that you are in agreeance with. For example, DNR, do not intubate, no inotropes, no vasopressors, whatever it is that you want to decide, but it needs to be your decision.

Next, provide or revoke advanced care directives. If an existing advanced care directive states, the patient wanted a DNR or NFR you may need to revoke or amend it. You can provide a new directive or a verbal order if legally allowed, but a written document is always more secure.

Next, confirm and monitor implementation, double-check with the nursing and medical team that the patient’s wristband or chart or ICU medical records all reflect the updated code status. I would highly recommend that you have access to the medical records at all times, and that should not be a big deal in this day and age. You should just have access to medical records online, through an app, through a website, it’s 2025.Don’t let hospitals tell you they can’t give you access to the medical records. It’s nonsense. They can. If they don’t want to, they have something to hide. Keep that in mind. Make sure that all staff that are working with your family member are aware, especially during handovers.

What are other important considerations? Hospitals must legally honor the patients or legal surrogates’ wishes, even if those differ from a prior DNR or NFR. In cases of dispute, i.e., between family members, request potentially a family meeting or a legal review immediately.

Once again, I would highly, highly recommend and suggest to stay away from hospital ethics committees because they’re not impartial and they’re not independent. Always request a copy of the updated DNR revocation for your records and like I said, do get access to the medical records, it is your right, it is not a privilege.

You can also, send it to hospital executive in the following manner. I am the patient’s healthcare proxy, legal representative, medical power of attorney. We are, or I am formally revoking the DNR order currently in place. Please update the medical records to reflect full code status immediately by 3 p.m. today, give them a deadline so there’s no ambiguity.

So, I hope this video empowers you to take the first steps to revoke DNR and NFR and do it now. Don’t waste any time because it’s life or death.

I have worked in critical care nursing for 25 years in 3 different countries, where I worked as a nurse manager for over 5 years in intensive care. I know everything that’s happening behind the scenes in an intensive care unit. I can very confidently say that we have saved many lives for our clients in intensive care. And you can verify that if you go to intensivecarehotline.com, if you look at our testimonial section or if you go to intensivecarehotline.com and if you look at our podcast section where we have done client interviews. Because our advice is absolutely life changing.

The biggest challenge for families in intensive care is that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights. They don’t know how to manage doctors and nurses in intensive care, and that is the biggest challenge.

You can join a growing number of members and clients that we have helped over the years because we improve your life instantly, by making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always.

That’s why I do one-on-one consulting and advocacy  over the phone, Zoom, WhatsApp, whichever medium works best for you, Google Meet, or Microsoft Teams, whichever medium works best for you. And I talk to you and your families directly. I hand hold you through this once in a lifetime situation that you simply cannot afford to get wrong, initially offer a 15-minute free consultation, and then I have obviously paid consulting and advocacy options.

I also talked to doctors and nurses directly with you on your behalf where I set you up with the right questions to ask. And I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care. I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org  directly. In the membership, you also have exclusive access to 21 ebooks and 21 videos that I have personally written and recorded and all of that will help you to make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment, always.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

If you like my videos, subscribe to my YouTube channel regular updates for families in intensive care. Click the like button, click the notification bell. Comment below what you want to see next, what questions and insights you have from this video,share the video with your friends and families.

I also do a weekly YouTube live where I answer your questions live on the show, and you will get notification for the YouTube Live if you are a subscriber to my YouTube channel, or if you are a subscriber to my intensivecarehotline.com email newsletter at intensivecarehotline.com,

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.