This week's palliative care discussion is on the topic of Outside the Hospital DNR forms. This is different from an Advanced Directive, because in addition to outlining your wishes regarding CPR and other medical interventions, it is signed by a physician. Which makes it official. This is necessary in order for Emergency Medical Service providers (EMS) not to attempt resuscitation if they are called.
Sometimes people think if they have an Advanced Directive that outlines their wishes, or tell EMS personnel they don't want to be resuscitated, or they have DNR tattooed on their chest, it will prevent them from having CPR performed. No, no, and no. Below is another example of a form that can be used. It is a bit simpler than the one above.
The hot pink form in the first photo is a TPOPP form. It is for Kansas and Missouri. TPOPP stands for Transportable Physician Orders for Patient Preferences. It has 4 areas and allows you to outline your wishes about CPR (do it or don't do it), what level of medical intervention you want if you have a pulse and/or are still breathing (1. comfort measures only, 2. do some limited things and going to the hospital is ok but likely no ICU level care, or 3. go ahead and take me to the hospital - even the ICU is ok with me), your wishes regarding medically administered nutrition (including feeding tubes), and finally signatures.
It is paramount that you talk to your medical provider about a form like this if you want one. They are generally for people who have a serious illness and know they don't want to be resuscitated if they die. For me, at my stage of life, and knowing that I want the first ticket I am handed it makes sense for me to have one. Remember, I see a lot of stuff and talk about serious illness everyday. This is not something to be done without a great deal of forethought.
I will be standing by for your comments and questions.
Helpful links:
Here is a place where you can see if your state has a specific form for an outside the hospital DNR form: POLST programs in your state
For more information about the specific parts of a POLST (Physician Orders for Life-Sustaining Treatment) form: Elements of a POLST form