1. The Ins and Outs of Inpatient DNR and Out of Hospital DNR forms
Lindsey Shelley, FNP-C
United Regional Hospital Palliative Care

2. What Is An Out of Hospital Do Not Resuscitate (OOHDNR)?
A legal form that tells emergency medical professionals NOT to start or continue certain life-saving procedures.
Resuscitation is when someone who has stopped breathing and whose heart has stopped beating is restored to consciousness.
If you are not in the hospital and have a medical emergency that makes you unconscious, emergency medical professionals may be called to help.

3. 5 Procedures Listed In OOHDNR Form
If you have a valid Out-of-Hospital DNR, EMS will NOT use any of the five procedures listed in the Out-of-Hospital DNR form to revive you.
Cardiopulmonary Resuscitation
Transcutaneous Cardiac Pacing
Defibrillation
Advanced Airway Management
Artificial Ventilation

4. Out of Hospital DNR (OOHDNR) Tips
There is a front and back side of the form
The form MUST have both sides completed to be valid
DO NOT make copies of document when patient is initially filling the form out; print from PDF file to make sure words are not blurred.
If I am a healthcare professional, how do I fill out an OOHDNR form and make sure it is legal?

5. OOHDNR Form (Front Side)

6. OOHDNR Form (Front Side) Section A

7. OOHDNR Form (Front Side) Section B

8. OOHDNR Form (Front Side) Section C

9. OOHDNR Form (Front Side) Section D

10. OOHDNR Form (Front Side) Section E

11. OOHDNR Form (Front Side) Two Witnesses Section

12. OOHDNR Form (Front Side) Section F

13. OOHDRN Form (Back Side)

14. OOHDRN Form (Back Side)

15. Who Can Be A Witness For An OOHDNR?
Anyone NOT directly involved in the care of the patient
Ex: social workers, case manager, PICC nurses if they are not on the unit caring for other patients, one of the management team, diabetes educators, RN nurse navigators, diabetes APPs, other APPs in other areas, chaplains, people who provide nutrition services, charge nurse, and Palliative RN if not on the case
Witness 2
Any competent adult

16. Inpatient DNR

17. What Is An Inpatient DNR?
Texas Hospital Association
Senate Bill 11-Implemented in 2017
The Texas Hospital Association met in October 2018 at a summit to share questions about Senate Bill 11 and discuss how best to comply with requirements.
Can be very confusing

18. Inform the patient of the order’s issuance
Senate Bill 11
Section of Senate Bill 11 states that
The ATTENDING PHYSICIAN must issue the order
Texas Senate Bill 11
Act in effect starting April 1, 2018
DNR order must be disclosed to the individual
“Before placing in a patient’s medical record a DNR order… the physician, physician assistant, nurse, or other person acting on behalf of a health care facility shall:
Inform the patient of the order’s issuance
If the patient is incompetent, make a reasonably diligent effort to contact…the patient’s known agent under a medical power of attorney or legal guardian”
“A DNR order issued for a patient is valid only if the patient’s attending physician issues the order”

19. URHCS Inpatient DNR Form

20. Do Long Term Care Facilities need an Inpatient DNR to abide by Senate Bill ?
Inpatient DNR applies to Long Term Care Facilities, but does NOT apply to assisted living type facilities.
An OOHDNR should be honored and sufficient at assisted living type facilities.

21. Facts
According to the Texas Department of State Health Services, a person who wears a bracelet or necklace (called a device) does NOT have to carry the form with them; the DNR device shall be honored in lieu of a DNR form.
However, we recommended that you have OOHDNR form with you at all times
Refrigerator

22. Examples of devices

23. Texas OOHDNR Device
(1) An intact, unaltered, easily identifiable plastic identification OOH DNR bracelet, with the word "Texas" (or a representation of the geographical shape of Texas and the word "STOP" imposed over the shape) and the words "Do Not Resuscitate", shall be honored by qualified EMS personnel in lieu of an original OOH DNR Order form. OR
(2) An intact, unaltered, easily identifiable metal bracelet or necklace inscribed with the words, "Texas Do Not Resuscitate - OOH" shall be honored by qualified EMS personnel in lieu of an OOH DNR Order form. 

24. Examples of Approved Manufacturers of Vinyl OOHDNR Bracelets
Texas Medical Association ATTN: DNR form 401 W. 15th Street Austin, Texas Order line:  (512)
Approved Manufacturers for Metal Devices
American Medical Identifications, Inc. Suite Wakefield Houston, Texas (800)
MedicAlert Foundation, Inc Colorado Ave. Turlock, California (888)
Caring Advocates  Argonauta St Carlsbad, California (800)
StickyJ Medical ID Endeavour Way #B Seminole FL (866)
MUST send a copy of OOHDNR form to company that is providing an OOHDNR medallion

25. Frequently Asked Questions
Can a DNR tattoo be honored in lieu of a Texas OOHDNR bracelet or completed OOHDNR form? NO

26. Questions

27. Helpful Resources
nr.shtm

28. References
file:///C:/Users/linds/Downloads/THA_Report_SB11 _FINAL.pdf Out-of-Hospital DNR Order: Information and Answers. (2019, January 4). Retrieved from order-information-and-answers Texas Out of Hospital Do Not Resuscitate Program, EMS & Trauma Systems. (n.d.). Retrieved from .shtm#devices