Over the past few months we have been going over the different types of advance care planning documents. You may remember from last month when talking about Do Not Resuscitate (DNR) orders in the hospitals, that a DNR order is situation specific. This means that if you go into the hospital on June 1 and have a DNR order, that order expires when you are discharged from the hospital. If you go back to the hospital on August 8, you will need a new DNR order.
So what happens in between? If you want to remain DNR even if you are not in the hospital, there is a document called an Out of Hospital DNR order. This is a very specific document that must be completed, including being signed by a physician, in order to be valid. I've often had people tell me they have an out of hospital DNR (OOHDNR), but when they show it to me, they show me their Directive to Physicians and Surrogates, or Living Will, but these are two separate documents. I can understand the confusion, especially if you have specifically written in your Living Will that you don't want resuscitation. But remember, any DNR is a doctor's order, and must be signed by a doctor.
The Texas OOHDNR can be a very complicated document to fill out correctly. You can find a copy of the document
here. Following are some step by step directions on correct completion of the document.
- The original form should be printed front and back (2 pages total). This is needed so that the person completing the form has a copy of the directions and definitions.
- If you are competing the form for yourself, you complete section A.
- If you are completing the document on behalf of someone else as a legal guardian or medical power, you complete section B.
- If you are completing on behalf of a family member and there is no legal guardian or medical power of attorney, you complete section C.
- Use of section D is rare, and is signed by an attending physician if the patient is not able to make the decision, but told the physician in front of witnesses that they did not want to be resuscitated.
- You complete section E if you are signing on behalf of a minor child.
All of the above sections include a printed name, date, and signature of the person completing the document.
In the section after E, either two witnesses OR a notary public signs the document. If signed by witnesses, one witness can be any adult. There are limitations on the other witness, and these limitations are spelled out on the back of the form, but generally those who cannot witness include family members or direct healthcare provider.
Below the witness signatures is space for the physician to sign. The physician needs to include his or her license number.
If there are no qualified adults to sign the OOHDNR, and the patient has been DNR in the hospital, an attending physician can sign the OOHDNR in Section F.
The most common problem to a properly completed OOHDNR is not signing the document twice. EVERY person who signs the document signs a second time at the bottom, below section F. This includes the physician and witnesses.
Once you have the completed document, what now? Keep the document, or a copy of the document readily available. I've heard stories of families calling 911 in a panic, but then they can't produce the OOHDNR and CPR is performed anyway. Remember, the paramedics must be able to see the document in order to honor the document. There are medical alert bracelets available on the link already provided, but I've heard paramedics say that even with a bracelet, they will need to see the actual document in order to honor it.
Next month we'll conclude our series on Advance Directives when we talk more about the Directive to Physicians, or Living Will.
