The Commonwealth of Massachusetts

Executive Office of Health and Human Services
Department of Public Health
Center for Quality Assurance and Control
99 Chauncy Street, 2nd Floor, Boston, MA 02111
617-753-8000

MITT ROMNEY
GOVERNOR
KERRY HEALEY
LIEUTENANT GOVERNOR
TIMOTHY R. MURPHY
SECRETARY
PAUL J. COTE, JR.
COMMISSIONER	
CIRCULAR LETTER: DHCQ 06-8-464

TO:		Long-Term Care Facility Administrators

FROM:	Paul Dreyer, Ph.D., Associate Commissioner

DATE:	August 15, 2006

RE:		Comfort Care Forms for Residents in Long Term Care Facilities

The purpose of this letter is to remind Long Term Care providers of the importance of obtaining a valid Comfort Care/DNR form for each resident with a valid Do Not Resuscitate (DNR) order.  The Comfort Care/DNR form is the only means by which ambulance services and their emergency medical technicians and paramedics (EMTs) may verify the existence of a valid DNR.  Without a properly executed Comfort Care/DNR form, EMTs are required to resuscitate a patient.  With a properly executed Comfort Care/DNR, EMTs will provide only palliative care to a patient they transport. 

In a previous circular letter (Circular Letter DHCQ 05-04-448), the Department of Public Health notified all stakeholders that a Long-Term Care Facility may cancel an ambulance call for a resident who is in cardiac or respiratory arrest if it subsequently discovers that there is a DNR order for the resident.  In this case, the facility can simply cancel the ambulance, or, if it has arrived, turn the EMTs and the ambulance away. 

If, however, the Long Term Care Facility wants to have a resident with a DNR transported to a hospital, the resident must have a fully executed Comfort Care/DNR form, so that the EMTs may recognize the DNR and provide only palliative care.  The EMTs will need a copy (they do not need the original) of the Comfort Care/DNR to take with the resident during the transport.

To be considered valid, the Comfort Care/DNR form must be fully filled out, and signed by the physician or nurse practitioner who cares for the resident.  If a nurse practitioner signs the form, the name of the physician who collaborates or supervises the nurse practitioner must be listed on the form.  (This physician need not sign the form, though.)  The easiest way to ensure there is a valid, signed Comfort Care/DNR form for each DNR resident is to have the physician or nurse practitioner sign it at the same time he or she is signing the DNR form itself.

Please contact Jill Mazzola at (617) 753-8106 if you have any questions in this matter.