Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them
Yuen, Jacqueline K
Reid, M Carrington
Fetters, Michael D
Journal of general internal medicine 2011 Jul; 26(7): 791-7
Do-not-resuscitate (DNR) orders have been in use in hospitals nationwide for over 20 years. Nonetheless, as currently implemented, they fail to adequately fulfill their two intended purposes--to support patient autonomy and to prevent non-beneficial interventions. These failures lead to serious consequences. Patients are deprived of the opportunity to make informed decisions regarding resuscitation, and CPR is performed on patients who would have wanted it withheld or are harmed by the procedure. This article highlights the persistent problems with today's use of inpatient DNR orders, i.e., DNR discussions do not occur frequently enough and occur too late in the course of patients' illnesses to allow their participation in resuscitation decisions. Furthermore, many physicians fail to provide adequate information to allow patients or surrogates to make informed decisions and inappropriately extrapolate DNR orders to limit other treatments. Because these failings are primarily due to systemic factors that result in deficient physician behaviors, we propose strategies to target these factors including changing the hospital culture, reforming hospital policies on DNR discussions, mandating provider communication skills training, and using financial incentives. These strategies could help overcome existing barriers to proper DNR discussions and align the use of DNR orders closer to their intended purposes of supporting patient self-determination and avoiding non-beneficial interventions at the end of life.
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Statement on Resuscitative Intervention for Patients Who Have Suffered in-Hospital Cardiopulmonary Arrest: The Issue of Do-Not-Resuscitate (DNR) Orders March 24, 1985. 8 P Unknown author (Joint Committee on the Care of the Terminally Ill; Committee on Medicine in Society; Committee on Public Health; and New York Academy of Medicine, 1986)
Long-Term Effects of Ethics Education on the Quality of Care for Patients Who Have Do-Not-Resuscitate Orders Sulmasy, Daniel P.; Terry, Peter B.; Faden, Ruth R.; Levine, David M. (1994-11)OBJECTIVE: To assess the long-term clinical impact of a broad-based ethics education program for medical houseofficers with specific emphasis on appropriate care for patients who have do-not-resuscitate (DNR) orders. ...
Long-Term Effects of Ethics Education on the Quality of Care for Patients Who Have Do-Not-Resuscitate Orders Sulmasy, Daniel P.; Terry, Peter B.; Faden, Ruth R.; Levine, David M. (1994-11)