Do-Not-Resuscitate (DNR) Orders
December 1, 2023 | Health System Risk Management
A do-not-resuscitate (DNR) order is an advance directive that specifically prohibits medical personnel from using cardiopulmonary resuscitation (CPR) measures to preserve life in the event of cardiac or respiratory arrest. For cardiac arrest, measures may include chest compressions, electrical stimulation, or the use of medications to support or restore the heart's ability to function. For respiratory arrest, treatment may include intubation (i.e., insertion of a tube through the mouth or nose into the trachea) to artificially support or restore breathing through mechanical ventilation.
CPR may be the only medical intervention that does not require an order from a licensed provider to execute but does require an order to prevent. Because initiating CPR is the default standard when a patient's wishes for end-of-life care are not known, principles of medical ethics, professional standards, organizational policies, emergency medical services protocols, and some state laws may require healthcare providers to perform CPR on all patients who have suffered cardiac arrest unless they are without a doubt deceased or there exists a valid DNR order.
Providing safeguards to ensure that patients' end-of-life treatment decisions and DNR orders are documented accurately in patients' medical records, that they are made readily available, and that they are followed should be a high priority for quality improvement professionals, risk managers, and patient safety officers. However, discussing, documenting, and implementing DNR orders remains problematic in many facilities despite an increased focus on improving the quality of end-of-life care, participating in advance care planning (ACP), and completion of advance directives.
ECRI and the ISMP Patient Safety Organization (PSO) identified 1,043 events related to end-of-life treatment choices that occurred between January 2016 and December 2018. Of these, a random sample of 300 events was reviewed and identified the following top four reported issues, which comprised nearly half of the data set(1):
Other studies have...