Do-Not-Resuscitate Orders for Critically III Patients in the Hospital
- 11 July 1986
- journal article
- research article
- Published by American Medical Association (AMA) in JAMA
- Vol. 256 (2), 233-237
- https://doi.org/10.1001/jama.1986.03380020095030
Abstract
We studied compliance with do-not-resuscitate (DNR) orders at a university hospital where a DNR protocol has existed since 1979. Documentation of DNR status in patient progress notes and chart orders increased through 1983. During a 12-month period (March 1983 through April 1984), we studied in detail the medical records of 521 patients who had a cardiopulmonary arrest in the hospital. Seventy-five percent (389 of 521) of these patients were designated DNR. Patients who were designated DNR were significantly more likely to be older, to have malignancy or an abnormal mental status, and to be less likely to have acute myocardial infarction, stroke, or chronic obstructive pulmonary disease than patients in whom resuscitation was attempted. Eighty-six percent of families, but only 22% of patients, were involved in the decision to designate a patient DNR. The decision to designate a patient DNR occurred late in the course of a patient's illness, often when the patient was in coma. For 28% of patients, some form of medical care was withdrawn or withheld after they were designated DNR. These data suggest that use of the DNR protocol requires changes if patients are to participate in the decision not to undergo cardiopulmonary resuscitation. (JAMA1986;256:233-237)This publication has 6 references indexed in Scilit:
- Analyzing Data from Ordered CategoriesNew England Journal of Medicine, 1984
- The Nature of Suffering and the Goals of MedicineNew England Journal of Medicine, 1982
- The Quality of MercyNew England Journal of Medicine, 1982
- Initial experience with a “code-no code” resuscitation system in cancer patientsCritical Care Medicine, 1980
- Autonomy for Burned Patients When Survival Is UnprecedentedNew England Journal of Medicine, 1977
- Orders Not to ResuscitateNew England Journal of Medicine, 1976