Understanding DNR Orders
Do Not Resuscitate (DNR) orders tell hospital staff not to perform potentially life-saving measures, such as CPR, if the patient’s heart and lungs stop working. In many states, a DNR order applies to staff outside the hospital (in nursing homes and emergency medical services) as well. A DNR order must be written by a healthcare provider (or, in some cases, certain other medical personnel). This can only be done with the patient’s or family’s consent. If a patient has not written an advance directive, the family with the help of the healthcare team will decide on a DNR.
The patient can cancel a DNR order at any time. The medical team can answer questions about the DNR form.
Writing a DNR order
When might a DNR order be written? When the patient's medical condition is such that, in the case of cardiac arrest, CPR and other resuscitation methods are not desired. This could be either because the chance of successful resuscitation is very low, or the focus of the care plan has shifted to comfort measures instead of life-sustaining measures. Coma and terminal illness are instances when a DNR order might be used.
In a coma, a patient does not respond to sight, sound, or touch. The heart and lungs could be working, but brain function is damaged due to trauma or disease.
In the last stages of heart disease, AIDS, cancer, and other illnesses, some patients don’t want to prolong their suffering. If recovery isn’t likely and quality of life is poor or getting worse, a patient or the family may agree to a DNR order.
DNR orders and hospice care
A hospice program can offer care during the final weeks of life. Hospice programs provide pain control and comfort care in the home or at special facilities. Hospice does not provide aggressive treatment. In fact, a DNR order will likely be discussed before a patient is admitted to hospice. A social worker or case manager may be able to help you arrange for hospice support.