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

Charoonratana, Victoria T; Stewart, Talia; Zhang, Runzhi; Li, Zhigang; DesBiens, Martha T; Slogic, Scott; Vergo, Maxwell T.

doi:10.1007/s11606-019-05431-7

Cited by 3 publications

(4 citation statements)

References 6 publications

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“…What is evident from this research is that more is required to protect patients than a paper and a decision by a medical team member, who can range from a physician to an EMS provider, with different levels of competency and training. Recent research into incorrect interpretation of hospital DNR revealed physicians, as a whole, but more so nursing and surgical specialties are more prone to make errors 21 . In this study, the relationship between a LW and POLST and the appropriate resuscitation decision was seen in only two instances ( Table 5 ).…”

Section: Discussionmentioning

confidence: 55%

“…Recent research into incorrect interpretation of hospital DNR revealed physicians, as a whole, but more so nursing and surgical specialties are more prone to make errors. 21 In this study, the relationship between a LW and POLST and the appropriate resuscitation decision was seen in only two instances (Table 5). The first being if no document existed and a default resuscitation, which is felt to be standard of care was provided.…”

Section: Discussionmentioning

confidence: 60%

“…Patient safety DNR & POLST order verifications tools have been created, published, and show promise but have not been adopted or validated in larger scales 13 . With error rates shown in larger more established systems adoption would seem prudent 21 . Research utilizing audio alone or audio and video show great promise.…”

Section: Discussionmentioning

confidence: 99%

“…13 With error rates shown in larger more established systems adoption would seem prudent. 21 Research utilizing audio alone or audio and video show great promise. Previous research (TRIAD VIII) with scripted patient to clinician video (SPCV) and EOL documents has demonstrated statistically significant improvement in understanding EOL documents.…”

Section: Discussionmentioning

confidence: 99%

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TRIAD XI: Utilizing simulation to evaluate the living will and POLST ability to achieve goal concordant care when critically ill or at end‐of‐life—The Realistic Interpretation of Advance Directives

Mirarchi

Juhasz

Cooney

et al. 2020

J of Healthc Risk Manag

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Objective Utilize simulation to evaluate if living wills (LW) or POLST achieves goal concordant Care (GCC) in a medical crisis. Methods Nurses and resident‐physicians from a single center were randomized to a clinical scenario with a living will (LW), physician orders for life sustaining treatment (POLST) or no document. Primary outcomes were resuscitation decision and time to decision. Secondary outcome was the effect of education. Results Total enrollment was 57 and less than 30% received prior training. Types of directives were linked to resuscitation decisions (P = .019). Participants randomized to “No Document” or POLST specifying “CPR” performed resuscitation. If a terminal condition presented with a POLST/ do not resuscitate‐comfort measures only (DNR‐CMO), 73% resuscitated. The LW or POLST specifying DNR combined with medical support resulted in resuscitations in 29% or more of the scenarios. Documents did not significantly affect median time‐to‐decision (P = .402) but decisions for “No Document” and POLST/CPR were at least 10 s less than other scenarios. Scenarios involving POLST DNR/Limited Treatment had the highest median time of 43 s. Prior training in LWs and POLST exerted a 10% improvement in decision making (P = .537). Conclusion GCC was not always achieved with a LW or POLST. This conclusion supports prior research identifying problems with the interpretation and discordance with LW's and POLST.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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TRIAD XI: Utilizing simulation to evaluate the living will and POLST ability to achieve goal concordant care when critically ill or at end‐of‐life—The Realistic Interpretation of Advance Directives

Mirarchi

Juhasz

Cooney

et al. 2020

J of Healthc Risk Manag

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Intent, Interpretation, and Influence of Do-Not-Resuscitate Orders

Valley

2024

CHEST Critical Care

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Variation in the design of Do Not Resuscitate orders and other code status options: a multi-institutional qualitative study

Batten¹,

Blythe

Wieten

et al. 2020

BMJ Qual Saf

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BackgroundUS hospitals typically provide a set of code status options that includes Full Code and Do Not Resuscitate (DNR) but often includes additional options. Although US hospitals differ in the design of code status options, this variation and its impacts have not been empirically studied.Design and methodsMulti-institutional qualitative study at 7 US hospitals selected for variability in geographical location, type of institution and design of code status options. We triangulated across three data sources (policy documents, code status ordering menus and in-depth physician interviews) to characterise the code status options available at each hospital. Using inductive qualitative methods, we investigated design differences in hospital code status options and the perceived impacts of these differences.ResultsThe code status options at each hospital varied widely with regard to the number of code status options, the names and definitions of code status options, and the formatting and capabilities of code status ordering menus. DNR orders were named and defined differently at each hospital studied. We identified five key design characteristics that impact the function of a code status order. Each hospital’s code status options were unique with respect to these characteristics, indicating that code status plays differing roles in each hospital. Physician participants perceived that the design of code status options shapes communication and decision-making practices about resuscitation and life-sustaining treatments, especially at the end of life. We identified four potential mechanisms through which this may occur: framing conversations, prompting decisions, shaping inferences and creating categories.ConclusionsThere are substantive differences in the design of hospital code status options that may contribute to known variability in end-of-life care and treatment intensity among US hospitals. Our framework can be used to design hospital code status options or evaluate their function.

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

Cited by 3 publications

References 6 publications

TRIAD XI: Utilizing simulation to evaluate the living will and POLST ability to achieve goal concordant care when critically ill or at end‐of‐life—The Realistic Interpretation of Advance Directives

TRIAD XI: Utilizing simulation to evaluate the living will and POLST ability to achieve goal concordant care when critically ill or at end‐of‐life—The Realistic Interpretation of Advance Directives

Intent, Interpretation, and Influence of Do-Not-Resuscitate Orders

Variation in the design of Do Not Resuscitate orders and other code status options: a multi-institutional qualitative study

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