Virginia Law

A. Health care personnel shall follow the procedures in this section when caring for a patient who is in cardiac or respiratory arrest and who may have a Durable DNR Order in effect.

B. Health care personnel shall initiate routine patient assessment and resuscitation or intervention until a valid Durable DNR Order or Other DNR Order can be confirmed.

C. Health care personnel may withhold or terminate resuscitation efforts only when:

1. An intact, unaltered original or photocopy of the Durable DNR Order Form, POST Form, or POLST Form, approved Alternate Durable DNR jewelry or Other DNR Order is located; and

2. The patient for whom the Durable DNR Order or Other DNR Order was issued is verified by identification with a photograph and signature or by positive identification by a family member or other person who knows the patient.

D. If the Durable DNR Order or Other DNR Order is intact, unaltered, and verified as issued for the patient, health care personnel may consider it valid.

E. In the event of cardiac or respiratory arrest of a patient with a valid Durable DNR Order or Other DNR Order, health care personnel shall withhold or withdraw cardiopulmonary resuscitation (CPR) unless otherwise directed by a physician physically present at the patient's location.

F. Health care personnel may provide the following interventions to a patient with a valid Durable DNR Order or Other DNR Order to provide comfort care or to alleviate pain.

1. Airway management, including positioning, nasal, or pharyngeal airway placement;

2. Suctioning;

3. Supplemental oxygen delivery devices;

4. Pain medications or intravenous fluids;

5. Bleeding control;

6. Patient positioning; or

7. Other therapies deemed necessary to provide comfort care or to alleviate pain.

G. If following a Durable DNR Order or Other DNR Order for a particular patient admitted to a qualified health care facility, health care personnel shall document care rendered or withheld as required by facility policies and procedures. If following a Durable DNR Order or Other DNR Order for a particular patient who is not admitted to a qualified health care facility or who is in transit from a health care facility, health care personnel shall document in the patient's medical record the care rendered or withheld in the following manner:

1. Describe assessment of the patient's cardiac or respiratory arrest status;

2. Document which identification (e.g., Durable DNR Order Form, Alternate Durable DNR jewelry, Other DNR Order, or alternate form of identification) was used to confirm Durable DNR status and that it was intact, not altered, and not revoked; and

3. Record the name of the patient's physician who issued the Durable DNR Order or Other DNR Order.

H. If the patient is being transported, the Durable DNR Order or Other DNR Order shall remain with the patient.

I. If family or others present at the patient's location contest the Durable DNR Order or Other DNR Order, EMS personnel shall contact the patient's physician or EMS medical control for guidance.

J. If there is any question about the validity of a Durable DNR Order, resuscitative measures shall be administered until the validity of a Durable DNR Order or Other DNR Order is confirmed.