A Do Not Resuscitate (DNR) order is a legally binding medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's heart stops beating or they stop breathing. Unlike advance directives, which are personal documents filled out by individuals, a DNR is a physician's order that requires a healthcare provider's signature to be valid.
11 steps across 3 sections
1. In-Hospital DNR
- Written as a physician's order in the patient's hospital chart.
- Applies only within that hospital or healthcare facility.
- Hospital staff (nurses, doctors, respiratory therapists) follow it.
- Does not travel with the patient if they are discharged or transferred (a new order must be written at the new facility).
2. Out-of-Hospital DNR (Prehospital DNR)
- A separate document designed for use outside hospital settings.
- Honored by EMS/paramedics, home health aides, nursing home staff, and other community-based providers.
- Must typically be on an official state-issued form that EMS personnel are trained to recognize.
- Should be kept in a visible, accessible location at home (e.g., on the refrigerator or by the bedside).
3. EMS and DNR
- Without a valid out-of-hospital DNR form physically present, EMS personnel are legally required to perform CPR. They cannot honor verbal requests from family members or refer to advance directives.
- Some states accept DNR bracelets or medallions (e.g., Medic Alert) as valid evidence of a DNR order.
- If EMS arrives and no DNR form is present, resuscitation will begin. It can be stopped once the form is located or a physician orders cessation.
Common Mistakes
- Confusing DNR with "do not treat"
- Not getting an out-of-hospital DNR
- Hiding the DNR form
- Using the wrong state's form
- Not informing family members
Pro Tips
- Have the conversation early
- Get both types
- Post it prominently at home
- Consider a DNR bracelet
- Coordinate with your advance directive and POLST
Sources
- DNR Orders vs. POLST Forms - Nolo
- Do Not Resuscitate - StatPearls / NIH
- Advance Directives and Do Not Resuscitate Orders - FamilyDoctor.org
- Understanding DNR Orders - UMass Memorial Health
- DNR Order vs. POLST Form: What's the Difference? - WillMaker
- Do-Not-Resuscitate Orders and Portable Medical Orders - MSD Manual
- DNR and POLST Forms - California EMSA
- Do Not Resuscitate - Wikipedia