Do Not Hospitalize

Do Not Hospitalize (DNH) 

Effective Date: [Original NPP Date] 
Revised Date: [Current Date] 

Goal: 

To ensure that all residents receive medical care in accordance with their wishes and advance directives. 

Policy: 

• After discussion with the resident and/or responsible party and in accordance with resident wishes and advance directives, the physician may write an order for “Do Not Hospitalize” if the resident has a “Do Not Resuscitate” (DNR) order. This discussion must be documented in the resident’s medical record. 

Procedure: 

• The physician will have a comprehensive discussion with the resident and/or their responsible party about the implications and scope of a “Do Not Hospitalize” (DNH) order. This conversation should include an explanation of the resident's current health status, prognosis, and the potential benefits and drawbacks of hospitalization versus remaining in the facility for care. 

• The discussion and the resident's or responsible party's decisions must be thoroughly documented in the resident's medical record. This documentation should include: 

• Date and time of the discussion 

• Names of all participants in the discussion 

• Summary of the information provided to the resident and/or responsible party 

• The resident’s or responsible party's expressed wishes regarding hospitalization 

• If the decision is made to proceed with a DNH order, the physician will write the order in the resident's medical record. The order should clearly state "Do Not Hospitalize" and must be signed and dated by the physician. 

• The resident's care plan will be updated to reflect the DNH order. This includes: 

• Notifying all relevant staff members of the DNH order 

• Ensuring that the resident's advance directives and DNR orders are consistent with the DNH order 

• Adjusting the resident's care plan to emphasize comfort measures and symptom management 

• The interdisciplinary team, including nursing, social work, and other relevant departments, will review the resident’s care plan to ensure that it aligns with the DNH order and supports the resident’s wishes. 

• In the event of a medical emergency, staff will follow the DNH order, providing appropriate care within the facility according to the resident's advance directives and care plan. Emergency protocols should focus on comfort and palliative care measures rather than transfer to a hospital. 

• Regular reviews of the DNH order and the resident’s care plan will be conducted to ensure ongoing compliance with the resident’s wishes and any changes in their condition or preferences. These reviews should be documented in the medical record. 

• If the resident’s wishes or health status changes, or if the responsible party requests a reassessment, the physician will revisit the DNH order with the resident and/or responsible party and make any necessary adjustments to the order and care plan. 

References: 

• Centers for Medicare & Medicaid Services. State Operations Manual, Appendix PP - Guidance to Surveyors for Long Term Care Facilities. [Link to current CMS SOM] 

• CMS Requirements of Participation for Long-Term Care Facilities. [Link to current guidelines]