Do Not Resuscitate Order (DNR) / Do Not Intubate (DNI) Policy

The Individuals with Disabilities Act (IDEA) and Section 504 of the American with Disabilities Act mandate that school districts provide a free and appropriate education for students with complex medical arid health needs. Educational services for medically fragile students may be provided in the regular education setting in order to meet the child’s educational needs in the least restrictive environment.

Due to the intense medical needs of some students with health impairments, parents/guardians may  request school personnel withhold emergency care of their child in the event of a life-threatening situation. In some cases parents/guardians may seek a Do Not Resuscitate (DNR) and/or Do Not Intubate (DNI) order from a physician.

In the event of a life-threatening medical emergency, educational personnel will contact the Emergency Medical System (911). Upon arrival, EMS personnel will be given the (DNR/DNI) orders.

Parents/guardians who request that educational personnel forgo life-sustaining treatment for their child should be advised of the following procedures:

1. Written orders received from parents/guardians to forgo life-sustaining treatment for their child or ward must be signed by the child’s physician and given to the School Nurse, Superintendent of Schools, Director of PPS and Principal.

2. Whenever a Do Not Resuscitate Order (DNR) or Do Not Intubate (DNI) is received, the Principal shall convene a multidisciplinary team that includes the child’s parents/guardians, physician, school nurse, and school personnel knowledgeable about the student and EMS personnel as appropriate.

3. The team shall determine specific interventions to be used by the school staff members in the event the child suffers a life-threatening episode during school hours or during a school event.
4. All students who are identified as having a Do Not Resuscitate (DNR) and/or Do Not Intubate (DNI) shall wear a current Do Not Resuscitate (DNR) and/or Do Not Intubate (DNI) bracelet.  Link Here.

a. It shall be the responsibility of the parents/guardians to obtain the DNR/DNI bracelet.
b. The DNR/DNI bracelet shall be kept with the student at all times to assure proper identification.
c. The bracelet and DNR/DNI order will be promptly displayed to emergency medical personnel responding to a school emergency

5. School nurse, Principal or designee shall notify parents immediately when an emergency occurs.
6. A copy of the signed DNR/DNI order shall be placed in the student health folder along with the team’s agreed upon procedure. The number on the order and number on the bracelet must match.
7. Student Confidentiality must be maintained.

a. Parents/guardians shall be consulted as to the disclosure of the student’s medical condition to the school staff and students.
b. The team shall decide which school personnel should be informed of the student’s condition.

8. All DNR/DNI orders must be reviewed at least annually to determine continued appropriateness:

a. The parents/guardians must be involved in the review;

b. A physician contact shall be made in all cases;

c. A review shall be documented in the student health record; and

d. The parents/guardians shall sign the individual health care plan at least annually.

9. If a DNR/DNI order is rescinded, the parent must inform the School Nurse, Superintendent of

Schools, Director of PPS and Principal in writing and sign the rescission notice.

a. The Principal shall immediately inform the school nurse who shall write “DISCONTINUED” in large print across the student’s DNR/DNI order.

b. The Principal and school nurse shall be jointly responsible for informing the appropriate school personnel that the DNR/DNI order has been discontinued.

c. The school nurse shall revise the student’s individual health care plan to reflect the change in order and the student’s current needs.

LEGAL REFS.:    20 U.S.C. § 1401 et. seq.

                        34 CFR § 300.550-552109

                        CMR 11.12 (2002)

ABC School v. Mr. & Mrs. M., 1997 Mass. Super. LE 43 (Mass. Super. 1997)

Do Not Resuscitate Orders in Schools (RE9842), 105 American Academy of

Pediatrics No. 4, 878-879 (April 2000)

Reviewed, revised 9/27/12

Reviewed; revised:  7/11/17