We studied the use of do-not-resuscitate (DNR) orders at three teaching hospitals that did not have official protocols for such orders to see whether their use meets the goals (decision making before a crisis and promoting patient autonomy) that have been identified for such orders. We found that 20% of all patients had or were being considered for DNR orders, that the patient and/or family was usually involved (83%) in the decision not to resuscitate, but rarely involved (25%) in decisions to resuscitate, or in cases of no decision, that a wide range of care was provided to patients with a DNR status, and that partial resuscitative efforts would be employed in some cases. Our main conclusion in light of our findings is that DNR orders are currently not fulfilling their major goals. We offer six proposals for improving future DNR protocols.
KIE: Resuscitation orders were studied in three teaching hospitals that do not have official do-not-resuscitate (DNR) protocols, primarily to determine whether they met the goals of pre-crisis decision making and promotion of patient autonomy. Patients and families were rarely (25%) involved when no decision or a decision to resuscitate was made, while a DNR decision usually (83%) involved the patient and/or family. In almost 20% of the cases the family but not the competent patient was involved. A wide range of care and even partial resuscitative efforts were provided DNR patients. The authors conclude with six proposals to improve DNR protocols.