Reconsidering Do-Not-Resuscitate Orders in the Perioperative Setting

Byrne, Susan; Mulcahy, Svetlana; Torres, Myra; Catlin, Anita

doi:10.1016/j.jopan.2013.05.016

Cited by 10 publications

(6 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Uncertainty regarding the DNR order is intensified in the perioperative setting because of the unique nature of this environment 2,3 . It may be difficult for health care providers to determine whether cardiac arrest is related to the anesthetic, the procedure, or the progression of disease 5 . Advances in health care and technology have made many surgical interventions available for patients living with chronic, critical, and terminal conditions 6 .…”

Section: Description Of the Problemmentioning

confidence: 99%

“…Consequently, the anesthesia care provider resuscitates the patient with assisted ventilation, tracheal intubation, or cardiovascular medications 11 . Therefore, distinguishing between cardiac arrest related to the surgical event and that related to the natural progression of the disease is difficult 5,11,12 …”

Section: Description Of the Problemmentioning

confidence: 99%

“…11 Therefore, distinguishing between cardiac arrest related to the surgical event and that related to the natural progression of the disease is difficult. 5,11,12 According to the Centers for Medicare & Medicaid Services, patients must be involved in planning their care, a process referred to as advance care planning. 13 The process is ongoing and affords the patient, his or her family, and the interdisciplinary health care team an opportunity to reassess the patient's goals and wishes as the medical condition changes.…”

Section: Literature Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Do‐Not‐Resuscitate Orders in the Perioperative Environment: A Multidisciplinary Quality Improvement Project

Baumann¹,

Killebrew²,

Zimnicki³

et al. 2017

AORN Journal

View full text Add to dashboard Cite

Do-not-resuscitate (DNR) orders in the perioperative environment must be managed according to national and institutional guidelines. Health care professionals, including perioperative nurses, may be unfamiliar with the guidelines and unsure of their role in reevaluating a DNR order. We conducted a multidisciplinary quality improvement project at a metropolitan community hospital that aimed to improve health care providers' compliance with the institutional policy, nursing involvement in DNR reevaluation, and communication between providers. The project intervention was an educational fair preceded and followed by a survey measuring knowledge about DNR orders, institutional policy, and national guidelines; attitude toward and comfort with the reevaluation process; and the effectiveness of the communication processes. Knowledge of DNR orders improved (P < .0001) for three of four survey questions. Attitude, comfort, and communication also improved (P < .01). A chart audit two months after the intervention showed that compliance with the institutional policy increased by 75%.

show abstract

Section: Description Of the Problemmentioning

confidence: 99%

Section: Description Of the Problemmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Do‐Not‐Resuscitate Orders in the Perioperative Environment: A Multidisciplinary Quality Improvement Project

Baumann¹,

Killebrew²,

Zimnicki³

et al. 2017

AORN Journal

View full text Add to dashboard Cite

show abstract

“…[2][3][4] Common to these guidelines is the required discussion of resuscitation goals before surgery, including length of time and the details of resuscitation modalities. 5 It has been previously demonstrated that code status discussions (CSDs) before surgery are lacking, with the potential to lead to undue harm. 6 However, a process to ensure these conversations occur is not well described.…”

mentioning

confidence: 99%

Perioperative Code Status Discussions: How Are We Doing?

et al. 2021

View full text Add to dashboard Cite

Approximately 15% of patients with a code status of do-not-resuscitate (DNR) or do-not-intubate (DNI) present for surgery. Despite professional guidelines requiring discussions with patients regarding perioperative resuscitation, it is unclear whether these recommendations are consistently followed. Our review of 158 patient encounters with established DNR/DNI code status found that code status discussions (CSDs) were documented only 70% of the time, and code status orders were inconsistently entered to reflect those discussions. We present solutions to improve CSD documentation, including refining perioperative workflows, simplifying code status choices, optimizing electronic health record order entry, and a supplementary consent form to facilitate code status review.

show abstract

“…Data show that implementation of required reconsideration during the perioperative period has been slow, 9 although it has been recommended in professional society statements, including those of the American Society of Anesthesiologists (ASA), 10 the American College of Surgeons (ACS), and the Association of Perioperative Registered Nurses (AORN). 11 This article focuses on the need for surgeons and anesthesiologists to conduct required reconsideration discussions with patients regarding code status in the perioperative period-specifically, to determine how patients with a DNR order might choose to modify their code status while undergoing a procedural intervention.…”

mentioning

confidence: 99%

Strategies for Collaborative Consideration of Patients' Resuscitation Preferences

Kopecky

Pelletier

Miller³

2020

AMA Journal of Ethics

View full text Add to dashboard Cite

Procedural treatment teams encounter patients with preoperative do-not-resuscitate (DNR) orders who are seeking procedural interventions to improve their quality of life. Required reconsideration is the professional discussion standard that seeks to engage patients or their surrogate decision makers in revisiting patient preferences for rescinding or maintaining a DNR order perioperatively. This article canvasses features of a required reconsideration discussion and guidelines for adhering to this standard. Perioperative DNR Decision MakingSince the passage of the Patient Self-Determination Act in 1990, patients have been legally supported in their right to participate in and direct their own health care decisions. The law itself was written to encourage discussion between health care professionals and patients regarding autonomy, especially at the end of life. 1,2 The tenets of medical ethics similarly support patient autonomy in the context of perioperative decision making, complementing legal perspectives. 3

show abstract

Reconsidering Do-Not-Resuscitate Orders in the Perioperative Setting

Cited by 10 publications

References 7 publications

Do‐Not‐Resuscitate Orders in the Perioperative Environment: A Multidisciplinary Quality Improvement Project

Do‐Not‐Resuscitate Orders in the Perioperative Environment: A Multidisciplinary Quality Improvement Project

Perioperative Code Status Discussions: How Are We Doing?

Strategies for Collaborative Consideration of Patients' Resuscitation Preferences

Contact Info

Product

Resources

About