DNR, DDNR, Advanced Directive, Living Will, Physician Order—Which one can I use?

DNR, DDNR, Advanced Directive, Living Will, Physician Order—Which one can I use?

First and foremost, you can always contact medical control for advice.

State regulations allow the Durable Do Not Resuscitate Order (DDNR) to last throughout the patient’s life unless the patient or the person with medical power of attorney revokes it.

  • DDNR can be honored by any qualified health care personnel in any setting.
  • If the patient is not in a facility, receiving hospice or home care service, this form/authorized jewelry must be present.
  • A POST or POLST form is an authorized version of a DDNR.
  • Photocopies of DDNR forms are allowed
  • Crews should carry a copy of the DNR if transporting

Sometimes you are called to a residence or nursing home and they have a written physician order or other DNR document.  If the patient is in a healthcare facility (nursing home or other licensed facility), under hospice care or home health care services, a written physician order or facility specific document does suffice for DNR orders.  It must contain the same information (printed patient name, date of initiation, patient or authorized signature, physician name and signature, and physician phone number).

If you have a DNR patient, you can provide comforting measures such as oxygen, suctioning, pain medication, IV fluids and bleeding control.  Intubation, CPR, defibrillation and BVM are not permitted.

If you initiate CPR and find the proper DDNR forms, you can stop further measures.  This is a trying time for the family so your care will shift to comforting them.

If you have any doubts about the situation, contact medical control and discuss the situation with them.

If you would like more information about the Virginia DDNR program, please check out this website:  http://www.vdh.virginia.gov/emergency-medical-services/other-ems-programs-and-links/durable-do-not-resuscitate-program/

Forms, tip sheets for healthcare providers, links to the Code of Virginia and a training presentation can be found here.

Advanced Directives and Living Wills are not acceptable forms of DNR.  They are often completed to give guidance to family members when a need might arise and not signed by a physician, nurse practitioner or physician assistant.

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