DNR
Do Not Resuscitate — a physician order instructing medical personnel not to perform CPR if a patient's heart stops or they stop breathing.
A Do Not Resuscitate (DNR) order is a physician-signed medical order in the patient's medical record directing healthcare providers not to perform cardiopulmonary resuscitation (CPR) if the patient experiences cardiac or respiratory arrest. A DNR is distinct from an advance directive: an advance directive expresses the patient's general wishes, but only a physician-signed order in the medical record is binding on emergency and hospital personnel.
CPR survival rates in hospital settings average 17–20% for all cardiac arrests (2022 AHA data); for elderly patients with multiple serious comorbidities, survival to hospital discharge rates drop to 5–10%, and of those who survive, a meaningful proportion have neurological deficits. Understanding these realistic outcomes is central to the DNR decision-making conversation.
DNR orders apply within the institutional setting where they are written. A hospital DNR does not automatically transfer to an SNF or home setting — separate orders or POLST/MOLST documents are needed for care outside the hospital. In many states, EMS personnel will attempt resuscitation unless there is a specifically formatted out-of-hospital DNR order or POLST on-site.
Real-World Example
An 88-year-old with stage IV heart failure and stage IIIB lung cancer signed a DNR order with her cardiologist after a frank discussion of CPR survival rates; when she experienced cardiac arrest at the skilled nursing facility 6 weeks later, staff provided comfort care rather than CPR per her documented wishes.