CPR directive allows the patient to refuse in advance any attempt of resuscitation by chest compressions, medications, defibrillation (electric shock), or intubation (artificial breathing machine) if their heart or breathing malfunctions, or stops CPR directives are almost always used by people who are seriously or terminally ill or elderly. For them, the trauma involved in CPR is likely to do more harm than good, but emergency personnel is required to perform CPR unless a directive tells them not to.

A CPR directive is not the same as a DNR order. A DNR order is a doctor’s order made for seriously ill patients in healthcare facilities, including nursing homes. It expires when the patient leaves the facility.  Often patients say that they signed a directive at the hospital, not realizing that it expires when they leave the hospital. The Colorado CPR directive must be signed by both the individual (or the individual’s MDPOA agent or “proxy”) and his/her physician. Other CPR directive forms may not require a physician’s signature. Photocopies, scans, and faxes are just as valid as the original. If you have a MOST completed, having copies come in handy should you take the ambulance to the hospital, or are seeing a new specialist. You will want to give the hospital and doctors office a copy. CPR directives must be immediately visible to emergency personnel. At home, the best locations are right by the front door, on the refrigerator, or by the bedside of a bed-bound individual.

• 18% of seniors who have CPR at the hospital survive to be discharged
• out-of-hospital cardiac arrests showed a 5% survival to 1 year
• Patients who are elderly with chronic illness have an average survival rate of less than 5%.
• For those with advanced illness, survival rates are often less than 1%.
• For example, bedfast patients with metastatic cancer, who are spending fifty percent of their time in bed, have a survival rate of 0-3%.
• Between 1994 and 1995 researchers from Duke University watched 97 episodes of “ER”, “Chicago Hope”, and “Rescue 911”, taking note of when CPR was administered during each show. In these TV dramas, 75% of the patients served immediate cardiac arrest. That is a HUGE difference from real life and sets up unrealistic expectations for what happens when someone has CPR.

In the state of Colorado, we have a form called the MOST. It stands for Medical Orders for Scope of Treatment. It is not an advanced directive but should align with the wishes outlined in an advanced directive. Once signed, it’s a medical order set and is effective immediately. Should you want to change your mind, you may fill out a new MOST form and obtain a new signature from the physician. It is a 1-page, 2 sided document that consolidates and summarizes patient’s preferences for life-sustaining treatment. Click here to download the form This was created in 2010. You may be wondering what makes it different than a CPR directive. A MOST form also includes directions about life-sustaining measures in addition to CPR, such as intubation, antibiotic use, and feeding tubes The MOST form must be signed by a health care professional, such as a doctor or a nurse practitioner. The MOST form should be completed and then given to a physician for signature. The form or a copy of the form should travel with the patient. There is a section on the back that prompts individuals and providers to regularly review.

To learn more about the MOST form check out this video made for patients and Families provided by the Center for Improving Value in Health Care (CIVHC)