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What’s in a Do-Not-Resuscitate Order? Understanding the Impact on Pre-arrest Life Support and Factors Influencing Misconceptions

  • Victoria T. Charoonratana
  • Talia StewartEmail author
  • Runzhi Zhang
  • Zhigang Li
  • Martha T. DesBiens
  • Scott Slogic
  • Maxwell T. Vergo
Concise Research Report

INTRODUCTION

Discussion of code status in the event of cardiopulmonary arrest, such as FULL CODE or Do-Not-Resuscitate (DNR) status, has become the standard of care when a patient is admitted to the hospital. Some patients elect to avoid CPR, but have preferences for life support they are willing to receive prior to a cardiopulmonary arrest, which can be documented in an out-of-hospital Provider Orders for Life-Sustaining Treatments (POLST) form.1 The American Medical Association makes a clear statement that code status directs care at the time of cardiopulmonary arrest, and it should not impact life support delivered to a patient who is clinically deteriorating (still has a pulse and is breathing) unless otherwise directed by the patient.2

While studies have confirmed this association between DNR order status with care a provider would deliver when the patient still has a pulse and is breathing,3, 4few studies have examined how a provider’s discipline, training background, and years...

Notes

Acknowledgments

The authors thank Dr. Alan Garber and Dr. Jeffrey Munson for substantial help in creating this survey.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

References

  1. 1.
    Mirarchi FL, Cooney TE, Venkat A, et al. TRIAD VIII: Nationwide multicenter evaluation to determine whether patient video testimonials can safely help ensure appropriate critical versus end-of-life care. J Patient Saf. 2017. doi: https://doi.org/10.1097/PTS.0000000000000357 CrossRefGoogle Scholar
  2. 2.
    Wik L, Kramer-Johansen J, Myklebust H, et al. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. J Am Med Assoc. 2005. doi: https://doi.org/10.1001/jama.293.3.299 CrossRefGoogle Scholar
  3. 3.
    Puma J, Silverstein MD, Stocking CB, et al. Life-Sustaining Treatment: A Prospective Study of Patients With DNR Orders in a Teaching Hospital. Arch Intern Med. 1988;148(10):2193-2198. doi: https://doi.org/10.1001/archinte.1988.00380100067015 CrossRefPubMedGoogle Scholar
  4. 4.
    Stevenson EK, Mehter HM, Walkey AJ, et al. Association between do not resuscitate/do not intubate status and resident physician decision-making a national survey. Ann Am Thorac Soc. 2017;14(4):536-542. doi: https://doi.org/10.1513/AnnalsATS.201610-798OC CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Scarborough JE, Pappas TN, Bennett KM, Lagoo-Deenadayalan S. Failure-to-pursue rescue: Explaining excess mortality in elderly emergency general surgical patients with preexisting do-not-resuscitate orders. In: Annals of Surgery. ; 2012. doi: https://doi.org/10.1097/SLA.0b013e31826578fb CrossRefGoogle Scholar
  6. 6.
    O’Brien H, Scarlett S, Brady A, Harkin K, Kenny RA, Moriarty J. Do-not-attempt-resuscitation (DNAR) orders: Understanding and interpretation of their use in the hospitalised patient in Ireland. A brief report. J Med Ethics. 2018;44(3):201-203. doi: https://doi.org/10.1136/medethics-2016-103986 CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Section of Palliative MedicineGeisel School of Medicine at Dartmouth Dartmouth-Hitchcock Medical CenterLebanonUSA
  2. 2.Department of BiostatisticsUniversity of FloridaGainsvilleUSA
  3. 3.Section of Infectious DiseaseDartmouth-Hitchcock Medical CenterLebanonUSA
  4. 4.The Dartmouth Institute for Health Policy and Clinical PracticeLebanonUSA
  5. 5.Life SafetyDartmouth-Hitchcock Medical CenterLebanonUSA
  6. 6.Section of Palliative MedicineDartmouth-Hitchcock Medical CenterLebanonUSA

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