Note: information on this page is based on content originated by the National Institute on Aging and published on their website at www.nia.nih.gov. For more information, we recommend you read the entire article at this link. A Do Not Resuscitate Order is a physician's order to carry out the wishes of an individual who doesn’t want efforts to restore their heartbeat or their breathing. CPR (cardiopulmonary resuscitation) can sometimes restart a stopped heart. It is most effective in people who were generally healthy before their heart stopped. During CPR, the person responding repeatedly pushes on the chest with great force and periodically puts air into the lungs. Electric shocks (called defibrillation) may also be used to correct an abnormal heart rhythm, and some medicines might also be given. Although not usually shown on television, the force required for CPR can cause broken ribs or a collapsed lung. Often, CPR does not succeed in older adults who have multiple chronic illnesses or who are already frail. If a patient has very severe breathing problems or has stopped breathing, a ventilator may be needed. A ventilator forces the lungs to work. Initially, this involves intubation, putting a tube attached to a ventilator down the throat into the trachea or windpipe. Because this tube can be quite uncomfortable, people are often sedated with very strong intravenous medicines. Restraints may be used to prevent them from pulling out the tube. If the person needs ventilator support for more than a few days, the doctor might suggest a tracheotomy, sometimes called a “trach” (rhymes with “make”). This tube is then attached to the ventilator. This is more comfortable than a tube down the throat and may not require sedation. Inserting the tube into the trachea is a bedside surgery. A tracheotomy can carry risks, including a collapsed lung, a plugged tracheotomy tube, or bleeding. How can you be sure the medical staff knows that we don’t want efforts to restore a heartbeat or breathing? Tell the doctor in charge as soon as the patient or person making healthcare decisions decides that CPR or other life-support procedures should not be performed. The doctor will then write this on the patient’s chart using terms such as DNR (Do Not Resuscitate), DNAR (Do Not Attempt to Resuscitate), AND (Allow Natural Death), or DNI (Do Not Intubate). DNR forms vary by State and are usually available online. (See more information below.) If end-of-life care is given at home, a special non-hospital DNR, signed by a doctor, is needed. This ensures that if emergency medical technicians (EMTs) are called to the house, they will respect your wishes. Make sure it is kept in a prominent place so EMTs can see it. Without a non-hospital DNR, in many States EMTs are required to perform CPR and similar techniques. Hospice staff can help determine whether a medical condition is part of the normal dying process or something that needs the attention of EMTs. DNR orders do not stop all treatment. They only mean that CPR and a ventilator will not be used. These orders are not permanent—they can be changed if the situation changes. DDNR forms valid in the State of Virginia can be downloaded at this link. This link also offers a DDNR fact sheet and ways to purchase DDNR bracelets and necklaces. Key information regarding DDNRs in Virginia: Kansas offers a fill-in-the-blank form DNR form. The document must be dated signed by yourself and your doctor, and witnessed by another adult who is not a relative. If you are unable to sign the document, your health care power of attorney may sign the document for you. The document does not need a doctor’s signature if you are a member of a church which providers medical treatment by spiritual means (e.g. prayer). The witness must be at least 18 years old. The witness cannot be: For more information and a basic DNR form, see Kansas Do Not Resuscitate Directives, a downloadable document offered by Kansas State University Cooperative Extension Service. Care is There can make it more convenient for you to consider and create a Do Not Resuscitate Order. We can:
What is a Do Not Resuscitate Order (DDNR)?
What Can be Done if Someone’s Heart Stops Beating (Cardiac Arrest)?
What if Someone Needs Help Breathing or Completely Stops Breathing (Respiratory Arrest)?
Obtaining a Do Not Resuscitate Order
Durable Do Not Resuscitate Orders In Virginia
Do Not Resuscitate Orders in Kansas
How Care is There Can Help:
Resources for Do Not Resuscitate Orders:
Next Steps
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