Also Known As:
Do Not Resuscitate order, no-code order, OOH-DNR (Texas Out-of-Hospital DNR)
Type:
Legal medical directive
Primary Purpose:
To document the patient’s choice that no CPR, intubation, defibrillation, or other resuscitation be attempted if the heart or breathing stops.
When It Applies:
Once signed and witnessed, it remains in effect until revoked by the patient.
Who Is Involved:
The patient (or their authorized decision-maker), the attending physician, and a witness or notary in some cases.
Where It Occurs:
Signed at the home, the physician’s office, or the hospital. In Texas, an Out-of-Hospital DNR (OOH-DNR) is the form used outside hospital walls.
Duration:
Permanent until revoked. The patient or decision-maker can revoke at any time, verbally or in writing.
Coverage:
Free to obtain, Texas OOH-DNR forms are available from your physician or hospice agency at no cost.
Key Focus:
Honoring the patient’s wishes about end-of-life intervention, preventing unwanted CPR, and ensuring emergency responders know the patient’s choice.
Common Misunderstanding:
A DNR is not the same as refusing all medical care. The patient still receives every comfort medication, every nursing visit, and every other element of hospice care. It only refuses resuscitation.
What a DNR Does (and Doesn’t Do)
A Do Not Resuscitate order is a legal document that tells healthcare providers and emergency responders not to attempt CPR, defibrillation, or intubation if the patient’s heart stops or they stop breathing.
A DNR does not mean:
- Refusing pain medication
- Refusing other medical care
- Refusing antibiotics for an infection
- Refusing IV fluids if they are appropriate
- Withdrawing from hospice or any other care
Every other element of comfort care continues. The DNR only addresses what happens at the moment of cardiac or respiratory arrest.
Texas Out-of-Hospital DNR (OOH-DNR)
In Texas, the standard form used outside a hospital is the Out-of-Hospital DNR (OOH-DNR). It is recognized by EMS, paramedics, and emergency responders across the state. The form must be:
- Signed by the patient (or their authorized decision-maker)
- Signed by the attending physician
- Witnessed by two qualified witnesses, or notarized
- Kept visible, many families keep it on the refrigerator, by the front door, or with the patient at all times
If your loved one is in hospice with Lifted, our nurses will help you obtain and complete the OOH-DNR if you choose. The decision is entirely the patient’s and family’s.
How a DNR Fits With Hospice
Hospice does not require a DNR. A patient can be in hospice without one and a patient can revoke a DNR at any time. But for most hospice families, a DNR makes sense, it ensures that the family’s wishes are honored if the patient’s heart stops at home, on a Sunday afternoon, when emergency responders may otherwise begin CPR by default.
If you have questions about DNRs or want help completing the Texas form, the Lifted team can walk you through it. Contact us or speak to your hospice nurse at any visit.