Do Not Resuscitate Status/Advance Directives/Healthcare Power of Attorney (POA) Status

Table of Contents

Aliases

DNR, comfort care

Patient Care Goals

To acknowledge and maintain the variety of ways that patients can express their wishes about cardiopulmonary resuscitation or end of life decision making.

Patient Presentation

Inclusion/Exclusion Criteria

  1. Patients must have the following document or a valid alternative (such as identification bracelet indicating wishes) immediately available.
    1. Do Not Resuscitate (DNR) order – identifies that CPR and intubation are not to be initiated if the patient is in arrest or peri-arrest. The interventions covered by this order and the details around when to implement them can vary widely
  2. The document above is valid when it meets all of the following criteria:
    1. Conforms to the state specifications for color and construction
    2. Is intact: it has not been cut, broken or shows signs of being repaired
    3. Displays the patient’s name and the physician’s name
  3. If there is question about the validity of the form/instrument, the best course of action is to proceed with the resuscitation until additional information can be obtained to clarify the best course of action
  4. If a patient has a valid version of one of the above documents, it will be referred to as a “valid exclusion to resuscitation” for the purposes of this protocol

Patient Management

Assessment

  1. If the patient has a valid exclusion to resuscitation then no CPR or airway management should be attempted, however this does not exclude comfort measures including medications for pain as appropriate
  2. If CPR has been initiated and a valid exclusion to resuscitation has been subsequently verified, CPR may be discontinued and direct medical oversight contacted as needed

Treatment and Interventions

  1. If there is a valid exclusion to resuscitation and there are signs of life (pulse and respirations), EMS providers should provide standard appropriate treatment under existing protocols according to the patient’s condition
    1. Directives should be followed as closely as possible and direct medical oversight contacted as needed
  2. If for any reason an intervention that is prohibited by an advanced directive is being considered, direct medical oversight should be obtained

Notes – Do Not Resuscitate Status/Advance Directives/Healthcare Power of Attorney (POA) Status