Valid Do Not Resuscitate Order Template for Washington

Washington Do Not Resuscitate Order: Usage Steps

When completing the Washington Do Not Resuscitate (DNR) Order form, it is essential to be detailed and precise. This document is a critical directive for patients who wish to decline resuscitation in the event their heart stops or they stop breathing. It is a legal document that must be signed by both the patient or their legal healthcare proxy and the attending physician. The process involves filling out the form accurately and ensuring all necessary parties review and understand its contents before signing. Below is a step-by-step guide to assist in filling out the form correctly.

1. Start by entering the patient's full legal name at the top of the form. This ensures the document is correctly attributed to the intended individual.
2. Next, fill in the patient's date of birth and address. This information further identifies the patient and where they reside.
3. Read the declaration statement carefully. This section outlines the patient's wish not to have resuscitation efforts carried out in the event of cardiac or respiratory arrest. Understanding this part is crucial for both the patient and the healthcare proxy.
4. If the patient is capable, they should sign and date the form in the designated area. This action legally records their decision and consent.
5. If the patient is unable to sign due to physical or mental incapacity, a legal healthcare proxy, guardian, or power of attorney must sign on their behalf. Include the date of signing and the relationship to the patient.
6. The attending physician or authorized healthcare provider must then review the form for accuracy and completeness. Their signature is mandatory for the DNR order to be valid. Without this, emergency personnel may not honor the DNR. The physician should also include the date of their signature.
7. After completing the form, ensure that copies are made and distributed appropriately. The patient or their representative should retain a copy, and additional copies should be given to the attending physician and included in the patient’s medical records. It may also be advisable to inform close family members of the DNR order and its location.

This document is a crucial part of a patient's healthcare directive, especially for those with terminal illnesses or in palliative care. By following these steps, you can ensure that the patient's wishes are clearly documented and legally recognized. Remember, this form should be easily accessible and reviewed regularly in case the patient or their healthcare proxy decides to make any changes.

1. What is a Do Not Resuscitate (DNR) Order?

   A Do Not Resuscitate Order, commonly referred to as a DNR, is a legal document in Washington State. It instructs healthcare professionals not to conduct cardiopulmonary resuscitation (CPR) if a person's breathing stops or if their heart stops beating. This decision is typically made by the patient, often after consultations with healthcare providers, to avoid aggressive life-saving techniques in favor of a more natural process of dying.

2. How can someone obtain a DNR Order in Washington?

   To obtain a DNR Order in Washington, the patient or their healthcare proxy needs to have a discussion with the patient's physician. This conversation will revolve around the patient's health status, their understanding of the implications of a DNR Order, and their personal wishes regarding end-of-life care. Following this, the physician would fill out the DNR form, which must then be signed by both the physician and the patient or their legally authorized representative.

3. Who can consent to a DNR Order?

   Consent to a DNR Order can be given by:

   • The patient themselves, provided they are of sound mind and capable of making their own healthcare decisions.
   • A legally appointed healthcare proxy, if the patient is unable to make their own decisions.
   • Close family members, in accordance with Washington state law, if neither the patient nor a healthcare proxy is able to make decisions.

4. Is a DNR Order permanent?

   No, a DNR Order is not permanent. The patient or their designated healthcare proxy has the right to revoke or amend the order at any time. This can be done by informing the healthcare team or, in specific instances, by destroying the DNR documentation. It is crucial to communicate any change in the decision to all involved parties to ensure that the patient's current wishes are followed.

5. Does a DNR Order affect other treatments?

   No, a DNR Order specifically addresses the use of CPR in cases where the patient's breathing or heart stops. It does not impact the provision of other treatments or interventions a patient might be receiving. Patients with a DNR can still receive medication, nutrition, hydration, and other forms of care to keep them comfortable.

6. What happens if medical staff are not aware of a DNR Order?

   If emergency medical personnel or healthcare workers are not aware of a DNR Order, they are likely to perform CPR in a life-threatening situation. For this reason, it is vital for patients or their families to ensure that the DNR Order is easily accessible, and healthcare providers are informed about the existence of the order. Some individuals choose to wear medical alert bracelets or carry a card in their wallet to inform emergency personnel of their DNR status.

7. Where should a DNR Order be kept?

   A DNR Order should be placed in a location where it can be easily found by emergency personnel or healthcare providers. Common places include:

   • With the patient, such as in a wallet or attached to the refrigerator.
   • With the patient's healthcare proxy or family members who are likely to be present in an emergency.
   • In the patient’s medical record, if they are residing in a healthcare facility.
   • Registered in a statewide registry, if available, where healthcare providers can access it.
   These precautions help ensure the patient's wishes are respected even in emergency situations.

Filling out the Washington Do Not Resuscitate (DNR) Order form is a critical step for individuals who wish to make their own decisions about end-of-life care. However, mistakes in completing this form can lead to unwanted medical interventions. Here are nine common errors to avoid:

1. Not consulting with a healthcare provider before completing the form. It's essential to have a discussion with a healthcare professional to fully understand the implications of a DNR order.

2. Failing to use the patient's legal name. The name used on the form should match the name on the patient's identification to avoid any confusion during a medical emergency.

3. Incorrectly filling out the patient's date of birth, as this can lead to misidentification and potentially render the DNR invalid.

4. Omitting the signature of the authorized medical provider, which is crucial for the DNR order to be legally recognized and implemented.

5. Not properly dating the document. The date when the DNR order is signed is essential to determine its validity and currency.

6. Not having the form witnessed as required, which could question the authenticity of the patient's or the healthcare provider's signature.

   • Witnesses should not be related by blood or marriage to the patient.

   • Nor should witnesses stand to benefit from the patient's death.

7. Overlooking the need to review and potentially revise the DNR order periodically. Health conditions and preferences may change, necessitating a review of the DNR order.

8. Not communicating the existence of the DNR order to family members and all healthcare providers involved in the patient's care, which can lead to confusion and distress during emergencies.

9. Failing to keep the DNR order in an easily accessible location. In an emergency, healthcare providers must have immediate access to the document to honor the patient's wishes.

Making sure that the Washington Do Not Resuscitate Order form is correctly completed and processed is a critical step toward ensuring that a patient's end-of-life wishes are honored. Avoiding these common mistakes can provide peace of mind to patients and their families, knowing that their preferences will be respected during crucial moments.

When it comes to managing end-of-life care, the Washington Do Not Resuscitate (DNR) Order form is crucial for those who wish not to have CPR or advanced cardiac life support if their heart stops or they stop breathing. It's important to understand that this form is often just one piece of a broader legal and medical planning puzzle. Alongside a DNR, individuals and their families may consider other forms and documents to ensure their healthcare and personal wishes are respected and clearly communicated. Here are five significant documents that are commonly used together with a DNR order in Washington.

• Advance Directive (Living Will): This document allows individuals to state their wishes about medical treatment if they are unable to communicate due to illness or incapacity. Unlike the DNR, which specifically addresses CPR and advanced cardiac life support, an advance directive can cover a broad range of treatments and conditions.
• Power of Attorney for Healthcare: This designates another person (a proxy or agent) to make healthcare decisions on someone’s behalf if they become unable to do so. The scope of decisions under a power of attorney can be broad or limited, depending on how the document is drafted.
• Physician Orders for Life-Sustaining Treatment (POLST): This form complements a DNR by providing more comprehensive instructions regarding other life-sustaining treatments, such as the use of antibiotics, tube feeding, and intensive care. Signed by both a doctor and the patient, a POLST ensures that a patient’s wishes are followed by all healthcare providers.
• Last Will and Testament: Although not directly related to healthcare decisions, a Last Will and Testament is crucial for expressing one’s wishes concerning the distribution of their assets and the care of any dependents after death. This document helps to prevent legal complications and ensure that the individual's final wishes are honored.
• Organ and Tissue Donation Registration: For those who wish to donate their organs or tissues after death, registration documents can be filled out in advance. This is important as it can significantly impact the lives of others and needs to be clearly documented to ensure the individual’s wishes are carried out.

In combination, these documents can provide a comprehensive plan that respects an individual’s healthcare and personal wishes, making a challenging time slightly easier for everyone involved. It’s important for individuals and their families to discuss these options and make decisions that best suit their wishes and needs. Educating oneself about these documents, alongside consulting healthcare and legal professionals, can help ensure that plans for end-of-life care are as clear and effective as possible.

• Living Will: Similar to a Do Not Resuscitate (DNR) order, a living will express a person's wishes regarding medical treatment in situations where they are unable to communicate due to illness or incapacity. Both documents guide healthcare providers on care preferences.

• Healthcare Power of Attorney (POA): Like a DNR, a healthcare POA designates someone to make medical decisions on behalf of the individual if they are incapacitated. While the DNR specifically addresses resuscitation, a healthcare POA covers a broader range of medical decisions.

• Advance Directive: An advance directive encompasses both a living will and a healthcare POA. It lays out a person's healthcare preferences, including end-of-life care, and appoints a decision-maker. DNR orders are a component of this comprehensive plan.

• Medical Orders for Life-Sustaining Treatment (MOLST): Similar to a DNR, MOLST forms provide specific instructions about a range of life-sustaining treatments based on a patient’s current health status, including preferences on resuscitation, intubation, and use of ventilators.

• Do Not Intubate (DNI) Order: A DNI order is similar to a DNR in that it is a directive to medical personnel, specifically regarding the refusal of intubation. Both forms are used to direct care in critical situations according to the patient's wishes.

• Physician Orders for Scope of Treatment (POST): POST forms are similar to DNR orders, as they provide specific instructions for healthcare providers to follow in emergency situations, including preferences on resuscitation and life-sustaining treatments, based on discussions between physicians and patients.

• Organ Donor Registration: While focused on posthumous decisions, organ donor registration shares the anticipatory decision-making nature of a DNR, as it records an individual’s wishes regarding the use of their organs and tissues after death.

• Emergency Medical Services (EMS) DNR: An EMS DNR is a specialized form of a typical DNR order, designed specifically for emergency medical responders. Both documents instruct healthcare professionals not to administer CPR or other resuscitative measures.

• Durable Power of Attorney for Finances: Although primarily dealing with financial decisions, this document, like a DNR, involves designating someone to act on the individual's behalf under specific conditions. Both address planning and decision-making in critical or defined circumstances.

• Five Wishes Document: This comprehensive document covers personal, spiritual, and medical wishes at the end of life. Like a DNR, it includes statements about medical treatment preferences, but it also addresses comfort care, and the personal and spiritual aspects of end-of-life planning.

When completing the Washington Do Not Resuscitate (DNR) Order form, it’s important to be precise and thoughtful. A DNR order informs medical personnel not to perform cardiopulmonary resuscitation (CPR) if your breathing stops or if your heart stops beating. Here are crucial do's and don'ts to keep in mind:

1. Read the entire form carefully before filling it out to ensure you understand all the sections and terms.
2. Consult with your healthcare provider to discuss the implications of a DNR order and ensure it aligns with your health care wishes and needs.
3. Use black or blue ink to ensure that all entries are legible and can be copied clearly.
4. Include your full legal name, date of birth, and other personal information exactly as they appear on your official documents to avoid any confusion.
5. Clearly state your decision regarding resuscitation to avoid any ambiguity that could delay decision-making in an emergency.

6. Leave any sections incomplete. If a section does not apply, write “N/A” (not applicable) to indicate that you have reviewed the section.
7. Sign the form without a witness or notary present, as required by Washington state law to validate the form.
8. Rely solely on verbal instructions to healthcare providers or family members. Without a completed form, healthcare providers may initiate resuscitation efforts in emergencies.

• All patients can decide to have a Do Not Resuscitate (DNR) Order. While many individuals can express their wishes regarding a DNR, certain patients, such as those with severe cognitive impairments or those who are not legally competent, might not be able to make this decision for themselves. In such cases, family members or legal guardians often make healthcare decisions on their behalf.

• A DNR Order applies to all forms of medical treatment. A common misconception is that having a DNR Order means refusing all medical treatments. However, a DNR specifically addresses the use of cardiopulmonary resuscitation (CPR) in case of heart or breathing failure. Patients with a DNR can still receive treatments for pain, infections, or other health issues unless specified otherwise in an advance healthcare directive.

• A DNR Order is only for elderly people. People of any age with serious health conditions may consider a DNR Order. It's not exclusive to the elderly; rather, it's about the quality of life and medical wishes of people facing life-limiting illnesses or conditions.

• Emergency medical services (EMS) will not transport someone with a DNR. EMS providers will transport a patient with a DNR Order to a hospital if treatment is needed for a condition that is not related to the need for resuscitation. The DNR Order specifically instructs healthcare providers not to attempt CPR, but it does not limit other medical interventions or treatments.

• Signing a DNR Order requires a lawyer. While it's important to make informed decisions regarding a DNR and possibly discuss these decisions with legal and healthcare professionals, the process of completing a DNR Order in Washington does not require a lawyer. It must be signed by a qualified healthcare provider to be valid.

• Once signed, a DNR Order cannot be changed or revoked. A DNR Order is not permanent and can be revoked or modified at any time by the patient or their legal representative if the patient is unable to do so. Communication with healthcare providers is essential to ensure that the DNR Order reflects the patient's current wishes.

• A DNR Order is effective in any setting. While a DNR Order is valid in healthcare facilities and during transport by EMS, its recognition can vary in settings outside of formal healthcare facilities. For instance, a DNR might not be automatically recognized in a non-healthcare setting without proper communication and documentation present, such as a living will or POLST (Physician Orders for Life-Sustaining Treatment) form.

The Washington Do Not Resuscitate (DNR) Order form is a crucial document for individuals who wish to convey their wishes regarding resuscitation efforts in emergency situations. Understanding how to properly fill out and use this form can ensure that a person's healthcare preferences are respected. Here are six key takeaways concerning the Washington DNR Order form:

• A valid Washington DNR Order form must be completed by both the patient (or their legal healthcare representative) and a licensed healthcare provider. This ensures that the decision for a DNR order is made with both parties’ understanding and agreement.
• The form requires clear identification of the patient, including full name, birth date, and address, to prevent any confusion in emergency situations.
• It is essential for the form to be readily available. Patients or their representatives should keep copies in easily accessible locations at home and inform family members or caregivers of its existence and location.
• The DNR Order is specific to pre-hospital and hospital settings, meaning emergency medical personnel and healthcare providers must follow the instructions provided in the form regarding resuscitation.
• Discussing the decision with healthcare providers, family, and caregivers is important, as this ensures all parties understand the patient’s wishes regarding emergency medical care and resuscitation.
• The DNR order can be revoked by the patient or their healthcare representative at any time, which highlights the necessity of keeping communication open and documentation current.