The Do Not Resuscitate (DNR) order is a medical directive informing healthcare providers not to attempt cardiopulmonary resuscitation (CPR) if a person’s heart stops or they stop breathing. In residential settings—such as a private home, assisted living facility, or nursing home—this directive is known as an Out-of-Hospital DNR (OOH-DNR). Unlike an internal hospital DNR, which is part of the electronic medical record, the residence DNR must be a specific, state-sanctioned document, often called a Physician Order for Life-Sustaining Treatment (POLST) or similar form. Verification of this order is a continuous process for caregivers and family members, ensuring the document remains valid, accessible, and accurately reflects the patient’s current wishes.
Initial Verification Upon Admission or Service Start
The first and most critical point for verification occurs immediately upon a patient’s admission to a facility or the initiation of home health or hospice services. This process is mandatory because the default status in nearly all care environments is “full code,” meaning staff must attempt full resuscitation unless a valid DNR order is presented. Verification involves ensuring the physical document is present, signed by the appropriate physician or authorized provider, and meets all state-specific legal criteria.
For residents entering a nursing home, regulations often require a physician examination shortly after admission, which serves as a procedural check for all orders, including DNR status. If the OOH-DNR form is not immediately available at the time of transfer, the patient is treated as full code until the order can be verified and placed in the primary medical record. This initial verification step prevents a lapse in care planning and establishes the foundation for honoring the patient’s end-of-life wishes.
Routine Periodic Verification Requirements
Verification of a DNR order is a scheduled, cyclical requirement mandated by regulatory bodies to ensure ongoing compliance. In long-term care settings, a patient’s DNR status is subject to review during the comprehensive annual assessment, a requirement of the Minimum Data Set (MDS). This routine check guarantees that the document is still in the patient’s chart and is consistent with the current care plan.
Some state protocols for OOH-DNR forms specify a required re-certification interval, such as every 90 days, particularly for non-hospital DNRs managed by home health agencies. These periodic reviews serve as a structured opportunity for the care team to confirm with the patient or their legal decision-maker that the order still reflects their wishes. This process guards against the risk of outdated or overlooked directives, which could lead to unwanted interventions.
Event-Triggered Verification and Review
Certain non-routine medical or administrative events immediately trigger a mandatory re-verification and discussion regarding the patient’s DNR status. A primary trigger is a significant change in the patient’s medical condition, such as a new diagnosis, rapid functional decline, or progression of a terminal illness. These changes prompt a necessary conversation to confirm whether the existing order still aligns with the patient’s goals of care considering the new prognosis.
Location and Status Changes
A change in the patient’s location or level of care, such as temporary hospitalization followed by a return to the residence, also necessitates a complete re-verification process. This is because a facility’s internal DNR order may not automatically transfer or be recognized by a different institution, requiring a new order upon return. Any expression of doubt or a desire to change the order by the patient or surrogate requires an immediate formal review by the attending physician.
Administrative Updates
Administrative changes, including the designation of a new attending physician or a change in the legal Power of Attorney, also require the new party to review and endorse the existing DNR order.
Ensuring Validity for Emergency Medical Services Response
The verification process for a residence DNR is fundamentally different when considering an Emergency Medical Services (EMS) response. EMS personnel are legally bound to initiate full resuscitation measures unless they are presented with a specific, state-authorized OOH-DNR form. A facility’s internal chart notation or an old hospital DNR is insufficient for EMS to withhold resuscitation, making the OOH-DNR form the single most important document in a residential setting.
Verification in this context means ensuring the physical form is immediately accessible to first responders. The form must be complete, bearing the required signatures of the patient or surrogate and the physician. It must be displayed in a prominent, standardized location, such as on the refrigerator or near the front door. Copies of the valid OOH-DNR form should accompany the patient during any transport to a healthcare facility, ensuring continuity of the directive across care settings.