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Northwest Community EMS SystemPOLICY MANUAL Policy Title:DO NOT RESUSCITATE GUIDELINES/ Withdrawing or Withholding Medical TreatmentBoard approval: 2/18/10Effective:1/1/10Supersedes: 10/1/06No. D5Page:

How to fill out do not resuscitate guidelines

How to Fill Out Do Not Resuscitate Guidelines:

1. Begin by understanding the purpose of a do not resuscitate (DNR) order. DNR guidelines provide medical instructions in case an individual's heart stops or they stop breathing, indicating whether or not they wish to receive cardiopulmonary resuscitation (CPR) or other life-saving measures.
2. Consult with a healthcare professional, such as a doctor or nurse, to learn more about the specific guidelines and requirements in your area. They can provide you with the necessary forms or documents to fill out.
3. Carefully review and fill out the DNR form accurately. Ensure that all the required fields are completed, including the patient's full legal name, date of birth, and current medical condition. It may also ask for contact information of a healthcare proxy or next of kin.
4. Clearly indicate the patient's preferences regarding resuscitation. This can be done by checking the appropriate box or writing a clear and concise statement, such as "I do not wish to be resuscitated under any circumstances" or "I only want CPR if my chances of meaningful recovery are high."
5. If applicable, specify any additional medical interventions the patient may or may not desire, such as intubation, mechanical ventilation, or the use of specific medications.
6. Ensure that the DNR form is signed and dated by the patient or their legal representative. Some jurisdictions may also require witnesses or notarization, so familiarize yourself with the local legal requirements.
7. Keep a copy of the completed DNR form readily accessible, preferably in a visible location such as the patient's room or wallet. Inform relevant individuals involved in the patient's care, including family members, healthcare professionals, and emergency medical service providers, about the existence and location of the DNR order.

Who Needs Do Not Resuscitate Guidelines:

1. Individuals who have been diagnosed with a terminal illness and have discussed end-of-life care with their healthcare provider might consider do not resuscitate guidelines. These guidelines allow them to express their wishes regarding resuscitation efforts during a medical emergency.
2. Elderly individuals who have a diminished quality of life and do not wish to prolong their suffering through artificial means of life support may also opt for DNR guidelines.
3. People with advanced medical conditions, such as end-stage heart failure, chronic obstructive pulmonary disease (COPD), or advanced dementia, may consider DNR guidelines as part of their overall care plan.
4. In some cases, individuals who have experienced multiple, unsuccessful resuscitation attempts in the past may choose to have DNR guidelines in place to avoid additional unnecessary interventions.
5. The decision to have do not resuscitate guidelines is highly personal and should be made in consultation with a healthcare provider, taking into account the individual's medical history, prognosis, personal values, and goals of care.

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