The Foundation for Healthy Communities (FHC) serves as the leading resource for advance care planning which includes, Advance Directives, Portable Do Not Resuscitate (PDNR) and POLST Medical Orders. Our Health Care Decisions Coalition has healthcare provider representatives from many settings and institutions throughout our state as well as from EMS, the office of Guardianship, Estate planning and many community organizations. FHC is also a proud member of the National POLST Collaboration and serves on its’ board of directors.
An Advance Directive is a written document that identifies who you want to make medical decisions for you and is ONLY used when you are unable to make medical decisions for yourself. Although you may have written your wishes to have or not have specific treatments on your Advance Directive form, that document is used as direction for your healthcare agent (DPOAH) along with your medical team.
There are two specific forms that constitute Do Not Resuscitate (DNR) medical orders in New Hampshire:
1) “P-DNR” (portable DNR) Order: a bright pink document, recognized throughout the state and/or a Portable DNR wallet card signed by a Physician, Physician Assistant or Advanced Practiced Registered Nurse (APRN).
2) “POLST – Medical Order”: a bright yellow document recognized throughout the state, signed by a Physician, Physician Assistant, or Advanced Practiced Registered Nurse (APRN). A POLST medical order constitutes a DNR if it states ‘This will constitute a DNR Order, and no separate DNR order will be required”.
Neither a Living Will nor a Durable Power of Attorney for Healthcare (DPOAH) form is a valid Do Not Resuscitate (DNR) order. Neither a patient’s spouse nor a healthcare agent under a DPOAH may direct EMS providers to withhold resuscitation in the absence of a valid DNR order.
POLST – Medical Orders and Portable DNR forms are invalid if not reviewed and signed by a provider. The original signed copy needs to be with the patient at all times and kept in a place that emergency personnel will find it such as on the refrigerator or in the facility medical chart where the patient resides. Copies can be given to medical team providers and the patient’s agent/DPOAH.
Additional Notes:
-Under state law, a DNR bracelet or necklace may only be issued to patients who have a valid DNR order.
-For patients receiving care in a healthcare facility, a DNR order written by a physician, physician assistant, or APRN at that nursing home, hospital or other healthcare facility issued in accordance with the healthcare facility’s policies and procedures is valid for the time that the patient resides in that facility.
-All forms of DNR identified above remain valid during a transfer from one healthcare facility to another.
-A DNR order from another state should be honored as long as it is substantially similar to the NH statutory form.
-A patient or their DPOAH may revoke a DNR order at any time by destroying the DNR order and removing any DNR bracelet or necklace and by notifying the attending physician or APRN that they wish to revoke the order.
