Do Not Intubate (DNI) – Definition & Detailed Explanation – End-of-Life and Hospice Care Glossary

What is a Do Not Intubate (DNI) order?

A Do Not Intubate (DNI) order is a medical directive that instructs healthcare providers not to perform endotracheal intubation on a patient in the event of respiratory failure or cardiac arrest. Intubation involves inserting a tube into the patient’s airway to help them breathe, and it is a common procedure used in emergency situations to support a patient’s breathing.

When is a DNI order considered?

A DNI order is typically considered for patients who have a poor prognosis or a terminal illness and who do not wish to undergo invasive measures to prolong their life. It may also be considered for patients who have a high risk of complications from intubation, such as those with advanced age or underlying health conditions.

Who can request a DNI order?

A DNI order can be requested by the patient themselves, if they are of sound mind and able to make medical decisions. In cases where the patient is unable to make decisions, a healthcare proxy or a legally designated decision-maker, such as a family member or a healthcare provider, can request a DNI order on behalf of the patient.

How is a DNI order different from a Do Not Resuscitate (DNR) order?

While both DNI and Do Not Resuscitate (DNR) orders involve limiting medical interventions in certain situations, they are not the same. A DNR order specifically pertains to cardiopulmonary resuscitation (CPR) and instructs healthcare providers not to attempt resuscitation in the event of cardiac arrest. A DNI order, on the other hand, focuses on intubation and respiratory support.

What are the implications of a DNI order for end-of-life care?

A DNI order can have significant implications for end-of-life care, as it signifies the patient’s wishes to avoid aggressive measures to prolong their life. It allows the patient to have a more peaceful and natural death without the potential discomfort and complications associated with intubation. It also helps healthcare providers and family members understand and respect the patient’s end-of-life preferences.

How is a DNI order communicated to healthcare providers?

A DNI order is typically documented in the patient’s medical records and communicated to healthcare providers through various means. This may include placing a visible DNI order in the patient’s chart, discussing the order during medical rounds or team meetings, and ensuring that all relevant healthcare providers are aware of the patient’s wishes. In emergency situations, a DNI order may be communicated verbally to ensure prompt and appropriate care for the patient.