Durable Do Not Resuscitate Order
Virginia's Durable Do Not Resuscitate (DDNR) Order, passed by the Virginia General Assembly, allows qualified health care personnel to honor a patient's request for humane comfort measures, while avoiding resuscitation in the event of cardiac or respiratory arrest. Originally passed in 1992, and amended in 1994 and 1999, the regulations were revised on July 20, 2011.
The DDNR Order follows a patient throughout the entire health care setting and can be honored in pre-hospital settings, hospitals, nursing homes, and other licensed institutions. A Durable Do Not Resuscitate Order may be issued by a physician:
- for a patient with whom there is a bona fide physician/patient relationship as defined in the guidelines of the Board of Medicine, and only with the consent of the patient: or
- upon the request of a person authorized to consent on the patient's behalf in cases when the patient is a minor or incapable of making an informed decision regarding consent for a DDNR order.
Virginia law allows a DDNR Order to be issued to any patient. There are no age or health status requirements.
Patients with DDNR Orders will not receive the following interventions:
- Artificial Ventilation
- Defibrillation
- CPR
- Endotracheal intubation or other advanced airway management including supra-glotic devices such as the King airway or the LMA, or other airway devices that pass beyond the oral pharynx, such as the Combi Tube, PTL, etc.
- Cardiac resuscitation medications
Patients with DDNR Orders are still treated with comfort interventions that include:
- Patient positioning
- Supplemental oxygen
- Opening airway manually (not intubation or bag/valve mask ventilation)
- Suctioning
- Bleeding control
- Intravenous fluids
- Pain medications
- Support to family members
Revoking a DNNR Order
It is important to note that a DDNR order does not expire; it remains in effect until the patient or someone designated to act on the patient's behalf revokes the order.
Who may revoke a DDNR?
- The patient by destroying the DDNR, or removing the approved DDNR bracelet or necklace, or by verbally withdrawing the order; or
- The patient's physician; or
- The authorized decision-maker for the patient.
How does a DDNR Order differ from Advance Directive and a Living Will?
Advance Directive is a witnessed written document, voluntarily executed by the declarant; or a witnessed oral statement, made by the declarant subsequent to the time s/he is diagnosed as suffering from a terminal condition.
Living Will, also an advance directive, outlines an individual's wishes for treatment in the event they are unable, because of disease or injury, to make their wishes known. Living wills however, cannot be honored by EMS providers because the living will is not a medical directive containing information required by law and is not required to be signed by the patient's bona fide physician.
What can an EMS Provider Honor?
- Virginia Durable Do Not Resuscitate (DDNR) Orders
- "Other" DNR Orders that contain the equivalent information as the state form.
- Approved DDNR bracelets or necklaces
Note: As of July 21, 2011 legible copies of a DDNR order may be accepted by qualified health care providers and the original is no longer required.
DDNR Jewelry
Durable DNR bracelets and necklaces that can be honored in place of the Virginia Durable DNR Order by qualified health care providers are available from two approved vendors. Only approved necklaces and bracelets can be honored. The DDNR jewelry states "Virginia, Do Not Resuscitate", the person's name, the doctor's name and phone number, and any additional information that may fit, such as an allergy or additional contact number.
The 2017 version of the Virginia DDNR Order form, directions on purchasing DDNR Jewelry, and other helpful information can be downloaded from the Virginia Department of Health's DDNR Program website.