The Quality of Care Plans for Patients With Do-Not-Resuscitate Orders
Sulmasy, Daniel P.
Sood, Johanna R.
Ury, Wayne A.
Archives of Internal Medicine 2004 July 26; 164(14): 1573-1578
BACKGROUND: Care plans for patients with do-not-resuscitate (DNR) orders often fail to define limits other than cardiopulmonary resuscitation and fail to address other patient care needs. We studied the explicitness and comprehensiveness of care plans for patients with DNR orders and what factors were associated with this aspect of the quality of their care. METHODS: A cross-sectional study was conducted at Georgetown University Medical Center (GUMC), Washington, DC, and St Vincent Catholic Medical Centers (SVCMC), St Vincent's Hospital-Manhattan, New York, NY. Participants included 189 consecutive medical inpatients with DNR orders. RESULTS: A previously validated medical chart review technique termed concurrent care concerns (CCCs) measured whether 11 possible patient care needs had been addressed within 2 days of the DNR order. Reasons for the DNR order were documented in only 55% of cases, and a consent conversation was documented in only 69%. The mean number of total CCCs per DNR order was 1.55 (1.84 at GUMC and 1.29 at SVCMC; (P =.007). In a multivariate logistic regression analysis of low (
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Sulmasy, Daniel P.; Sood, Johanna R.; Texiera, Kenneth; McAuley, Ruth L.; McGugins, Jennifer; Ury, Wayne A. (2006-12)
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. ...