Blank Do Not Resuscitate Order Template

1. What is a Do Not Resuscitate (DNR) Order form?

   A Do Not Resuscitate (DNR) Order form is a legally binding document that tells healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a person's breathing stops or if the heart stops beating. It is used by individuals who wish to avoid life-prolonging measures in the event of cardiac or respiratory arrest.

2. How does a DNR Order work?

   Once a DNR Order is in place, medical staff will not initiate CPR. This includes not providing chest compressions, artificial ventilation, or electric shock to restart the heart. Other treatments, however, may still be provided to make the person comfortable unless additional orders, such as a living will or advance directive, specify otherwise.

3. Who can request a DNR Order?

   Generally, any competent adult can request a DNR Order for themselves. A legal guardian or health care proxy may also request a DNR on behalf of someone who is not able to make their own medical decisions.

4. Where is a DNR Order applicable?

   • In hospitals: Medical staff are required to follow the DNR Order once it is part of the patient's medical record.
   • In non-hospital settings: Individuals may wear DNR bracelets or carry DNR cards to inform emergency medical services (EMS) of their DNR status.

5. How can one obtain a DNR Order?

   To obtain a DNR Order, a person must speak with their healthcare provider to discuss their wishes. The healthcare provider will then document these wishes in the form of a DNR Order. Depending on the state, the form may also require a witness or notarization.

6. Can a DNR Order be revoked?

   Yes, a person can revoke their DNR Order at any time. This can be done by informing the healthcare team verbally or in writing. It is important to also remove any DNR bracelets or other indicators of the DNR status to prevent confusion.

7. What should be done with a DNR Order once it is completed?

   Once a DNR Order is completed, it should be placed in the medical records at a hospital or healthcare facility. Individuals should also inform family members, healthcare proxies, or guardians about the order. If applicable, carrying a DNR bracelet or card can ensure that the DNR wishes are respected outside of a hospital setting.

When dealing with the delicate matters of health directives and end-of-life planning, the completion of a Do Not Resuscitate (DNR) Order form stands as a crucial step for many individuals and their families. Though intended to ensure a person's medical and ethical wishes are respected, errors can occur during the process, leading to potential misunderstandings or procedural complications. Understanding some of the common mistakes can help individuals navigate this sensitive task with greater care and precision.

One frequent error is the failure to ensure the form is properly signed and witnessed. This critical oversight might render the document legally ineffective, leaving medical professionals in a precarious position regarding the patient's true wishes. In several jurisdictions, a DNR order must be signed by both the patient (or their legal representative) and a witness or even a healthcare provider in some instances. Ensuring every signature is properly placed and clearly legible is essential for the form's validity.

Another common mistake lies in not being specific enough about the individual's wishes. While the premise of a DNR is straightforward—to avoid resuscitation attempts in the event of cardiac or respiratory arrest—the specifics can sometimes be glossed over. For instance, individuals can outline under which circumstances the DNR should apply, or detail preferences regarding different lifesaving measures like intubation or mechanical ventilation. Without clear instructions, healthcare providers might be left to make split-second decisions without guidance.

Inadequate communication with family members and healthcare providers about the existence and contents of a DNR order is a misstep that can lead to significant emotional distress and confusion during emergencies. It is crucial that family and key healthcare providers not only know of the DNR's existence but also understand the person's wishes and the reasoning behind them. This awareness ensures that everyone involved is prepared to honor the individual's directions without hesitation.

Forgetting to review and update the DNR order regularly can lead to complications, especially as medical conditions change or new treatments become available. What might have been a clear decision at one point can become outdated, potentially conflicting with the individual's current health status and wishes. Regular reviews - typically on an annual basis or after a significant change in health status - ensure that the DNR order remains an accurate reflection of the person's current desires.

Lastly, many falter by not making multiple copies of the DNR order and ensuring they are readily accessible. It is beneficial to have copies available in the home, with family members, and in medical files at healthcare facilities. In times of crisis, the availability of the DNR order can prevent unwanted resuscitative efforts, ensuring that medical care aligns with the individual's wishes. Healthcare providers often look for these documents immediately in emergency situations, so accessibility is key.

In the realm of healthcare and personal wishes regarding end-of-life care, a Do Not Resuscitate (DNR) Order form plays a vital role. However, it's often just one piece of a broader suite of documents that individuals and families may consider to ensure their healthcare wishes are respected. These documents can complement a DNR to provide a more comprehensive approach to planning for healthcare decisions.

• Advance Directive - This document allows individuals to outline their preferences for medical treatment in various scenarios should they become unable to communicate these wishes themselves. It often includes instructions about the use of life-sustaining measures in addition to a DNR.
• Living Will - Similar to an advance directive, a living will specifically addresses an individual's preferences regarding end-of-life medical care, including life-prolonging treatments and interventions.
• Healthcare Power of Attorney (POA) - This legal document designates another person (a proxy) to make healthcare decisions on an individual's behalf if they are unable to make decisions themselves. It can specify which decisions the proxy has the authority to make, including those about implementing or revoking a DNR.
• Physician Orders for Life-Sustaining Treatment (POLST) - POLST forms are designed for seriously ill patients and provide specific instructions about treatments that are in line with the patient’s current health status and goals. This can include a DNR and goes beyond it to other life-sustaining treatments.
• Organ and Tissue Donation Form - For individuals interested in organ donation, this form records their consent to donate organs and tissues after death. This can be important in respecting the individual's wishes for helping others posthumously.
• Emergency Information Form - Although not strictly related to end-of-life decisions, this form contains critical information such as emergency contacts, known allergies, current medications, and existing medical conditions, which can be crucial in an emergency situation.

Together, these documents create a framework that ensures an individual's healthcare preferences are understood and respected at all stages of care. It's important for everyone to consider these documents, discuss their wishes with loved ones, and seek professional advice to ensure they are properly completed and accessible when needed.

A Living Will is quite similar to a Do Not Resuscitate (DNR) Order in that it expresses your wishes regarding medical treatment if you're unable to communicate them yourself. While a DNR specifically directs healthcare providers not to perform CPR in the event your heart stops or you stop breathing, a Living Will is broader, covering various life-sustaining treatments you may or may not want, like feeding tubes or mechanical ventilation.

A Healthcare Power of Attorney (POA) is another document related to a DNR. It designates someone you trust to make healthcare decisions on your behalf if you're unable to do so. Unlike a DNR, which is a direct instruction to healthcare professionals, a Healthcare POA appoints someone else to make those decisions for you, potentially including the decision to implement or uphold a DNR order based on your expressed wishes.

An Advance Directive combines elements of both a Living Will and a Healthcare POA. This document outlines your preferences for medical treatment (like a Living Will) and may also appoint a healthcare proxy or agent (similar to a Healthcare POA). By detailing your wishes ahead of time, it ensures that your preferences regarding treatment, including resuscitation, are known and can be followed by healthcare providers.

A Medical Orders for Life-Sustaining Treatment (MOLST) form is specifically designed for those with serious health conditions and outlines a range of life-sustaining treatment preferences, not just resuscitation. Similar to a DNR, it's a doctor's order that is followed by healthcare professionals, but it covers more ground, addressing treatments such as antibiotics, tube feeding, and dialysis, in addition to whether or not to attempt resuscitation.

A Durable Power of Attorney for Healthcare is similar to a Healthcare POA but is explicitly designed to remain in effect even if you become incapacitated or unable to make decisions for yourself. It's broader than a DNR because it covers all healthcare decisions, not just those related to resuscitation, but it shares the purpose of ensuring your health care wishes are respected when you're not able to voice them.

A POLST (Provider Orders for Life-Sustaining Treatment) form, much like a DNR and MOLST, translates your treatment preferences into actionable medical orders. It differs in detail and scope, but like a DNR, a POLST is intended for people who are seriously ill or at the end of life, making specific requests about the treatments they do or do not want to receive, including resuscitation efforts.

An Emergency Medical Information Form is a document that includes your medical history, allergies, medications, and the contact information of your next of kin. It's similar to a DNR because it's used in emergency situations to inform healthcare providers about your medical condition and treatment preferences, although it's more general and includes a wide range of information beyond resuscitation orders.

Finally, a Last Will and Testament, while primarily focused on the distribution of your property after death, can sometimes indirectly relate to a DNR. For instance, it may include instructions for handling your remains or specify your wishes regarding funeral arrangements, which could indirectly inform your loved ones and healthcare providers of your preferences about life-sustaining treatments or resuscitation efforts at the end of life.

When it comes to filling out a Do Not Resuscitate (DNR) Order form, knowing what to do and what to avoid can make a significant difference. These crucial steps ensure that your or your loved one's wishes are respected regarding resuscitation efforts during a medical emergency.

What You Should Do

• Make sure to have a detailed conversation with your healthcare provider. Understand completely what a DNR order entails, how it works, and how it will affect emergency medical care.
• Fill out the form accurately and legibly. Any errors or unclear handwriting can lead to misunderstandings in an emergency situation.
• Ensure the form is signed by the required parties. This usually includes the patient (or their legal representative) and the physician or healthcare provider.
• Keep the DNR order readily accessible. In an emergency, healthcare providers need to find and verify the DNR order quickly.

What You Shouldn't Do

• Don’t fill out the form without discussing it with your family. It’s critical that your family understands your wishes and why you’ve decided on a DNR order.
• Avoid leaving sections of the form blank. If a section doesn’t apply, mark it accordingly. Incomplete forms can cause delays or confusion.
• Do not forget to update your DNR order. If your health situation or wishes change, ensure your DNR reflects these changes accurately.
• Don’t keep your DNR order in a place where no one can find it. It’s vital that family members and healthcare providers know where it is stored.

Many people have misconceptions about Do Not Resuscitate (DNR) Orders, leading to confusion and anxiety around end-of-life decisions. Below are seven common misunderstandings and the truths behind them:

• A DNR applies to all medical treatments. This is not true. A DNR order specifically addresses the absence of cardiopulmonary resuscitation (CPR) if a person's heart stops or they stop breathing. It does not apply to other treatments or interventions a patient may receive.

• Only elderly patients can have a DNR order. The reality is that a DNR order can be appropriate for patients at any age whose medical conditions lead them (along with family and healthcare providers) to decide that CPR would not be beneficial for them.

• Having a DNR means you are giving up on life. Choosing to have a DNR order is not about giving up but rather about making a personal decision regarding the end-of-life care you wish to receive. It is about dignity and quality of life in one's final days.

• Doctors decide if a patient needs a DNR order. While doctors provide information about the patient’s health and the benefits and burdens of CPR, the decision to have a DNR order is ultimately up to the patient or their healthcare proxy if the patient is unable to make decisions.

• A DNR order is irreversible. This is incorrect. A DNR order can be revoked by the patient or their legally authorized representative at any time to align with the patient's current wishes about receiving CPR.

• If you have a DNR, doctors won't work as hard to save your life. This misconception is entirely unfounded. Healthcare providers continue to offer all other medically appropriate treatments and interventions, except for CPR, per the DNR order. The care plan focuses on comfort, dignity, and respect for the patient’s wishes.

• A DNR order must be signed by a family member. The truth is that the consent and signature of the patient, when capable, are what's primarily required for a DNR order. When patients cannot make their own decisions, a healthcare proxy or a legally authorized representative can make those decisions in accordance with the patient's wishes or best interests.

Understanding these facts can help individuals and families make informed decisions regarding DNR orders and end-of-life care planning.

The Do Not Resuscitate (DNR) order form is a critical document that requires thoughtful consideration and understanding. Here are key takeaways regarding the process of filling out and using a DNR form:

• Understand its purpose: A DNR order instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient’s heart stops beating.
• It’s a personal decision: Deciding to fill out a DNR form is a personal choice, often reflecting an individual's wishes regarding end-of-life care. It is important to discuss these wishes with family members and healthcare providers.
• Physician involvement is required: A DNR order must be signed by a licensed healthcare provider to be considered valid. This ensures that the decision is informed and reflects current medical advice.
• State laws vary: The requirements for a DNR order can differ from state to state. It is crucial to understand and comply with your state's laws to ensure the DNR order is legally valid.
• Discuss with healthcare providers: Before finalizing a DNR order, patients should have a thorough discussion with their healthcare providers to understand the implications and ensure that it reflects their medical needs and wishes.
• It can be revoked: The individual who filed a DNR can revoke it at any time. This revocation must be communicated clearly to healthcare providers to ensure that it is reflected in the patient’s medical records.
• Effective settings: Generally, a DNR order is effective in both hospital settings and at home. However, specific procedures for its implementation in different settings should be understood.
• Consideration in advance directives: A DNR order is often included as part of advance directives, which outline a person's wishes for medical treatment in scenarios where they are unable to communicate these wishes themselves.
• Emergency services might need notification: If a patient resides at home or in a community care setting, it’s advisable to inform emergency medical services (EMS) of the DNR order to ensure they honor it during an emergency.
• Documentation and accessibility: Always keep the DNR order in an accessible location. Family members and caregivers should know where the document is stored, and a copy should be readily available to present to healthcare professionals when needed.