Advance Directives and DNR Orders

An advance directive and a DNR order are related but not interchangeable. An advance directive records a capable person's preferences for future care. A DNR/no-CPR order is a clinician-signed medical order that tells the bedside team not to start CPR if the patient has cardiopulmonary arrest. The directive expresses the patient's voice; the order makes a specific decision operational. For U.S. patients, the two common advance-directive instruments are a living will and a durable power of attorney for health care. A living will describes treatment preferences. A durable power of attorney names a health care agent or proxy who can make decisions when the patient cannot. If no agent or guardian is available, the appropriate surrogate is determined by state law rather than by a single national hierarchy. The LVN/LPN verifies the current order and related documents, communicates code status during every transition, continues care that remains consistent with the patient's goals, and reports discrepancies immediately. The LVN/LPN does not independently interpret a disputed document, select a surrogate, or write or change a DNR order.