This is Google's cache of http://www.jwatch.org/em200310290000009/2003/10/29/dnr-orders-are-not-honored-long-term-care. It is a snapshot of the page as it appeared on Jun 30, 2015 03:24:32 GMT.
The current page could have changed in the meantime. Learn more
Full versionText-only versionView sourceTip: To quickly find your search term on this page, press Ctrl+F or ⌘-F (Mac) and use the find bar.
DNR Orders Are Not Honored in Long-Term-Care Facilities - NEJM Journal Watch

DNR Orders Are Not Honored in Long-Term-Care Facilities

Summary and Comment |
Emergency Medicine
October 29, 2003

DNR Orders Are Not Honored in Long-Term-Care Facilities

Kristi L. Koenig, MD, FACEP reviewing Becker LJ et al. Prehosp Emerg Care 2003 Jul/Sep.
  1. Kristi L. Koenig, MD, FACEP

Do-not-resuscitate (DNR) orders, even when present, are not universally followed by healthcare staff. These researchers assessed the response to cardiac arrest in patients with DNR orders at long-term-care (LTC) facilities. The investigators reviewed medical incident reports for emergency medical services-attended cardiac arrests at 466 facilities (31 nursing homes, 379 adult family homes, and 56 assisted-living centers) in Washington state over an 18-month period.

Caregivers called 911 for 392 patients in cardiac arrest, including 139 patients with DNR orders (35%). Cardiopulmonary resuscitation was attempted by EMS providers in 31% of cardiac-arrest patients with DNR orders at nursing homes, compared with 13% at adult family homes and none at assisted-living facilities; none of these patients survived. Among 253 patients without DNR orders, EMS personnel attempted resuscitation in 189 (75%), and 8 (4%) survived. The primary reason for calling 911 in nursing homes was staff concern about the validity of the DNR order, whereas the primary reason in adult family homes and assisted-living centers was concern about getting the appropriate medical authority to declare death.

Comment

  1. Kristi L. Koenig, MD, FACEP

The results of this study are discouraging and reveal that improved systems are needed to ensure that death with dignity can be provided for patients in LTC facilities. Caregivers should not be calling 911 for arrested patients with DNR status, and clear policies must be established at LTC facilities to prevent this. In addition, prehospital providers must be empowered to adhere to DNR orders without fear of litigation or other repercussions. Resuscitation of patients against their will is inappropriate, wastes EMS resources, and can place both providers and the public at risk during a lights-and-siren transport.

Reviewed Articles

Citation(s):

  1. Becker LJ et al. Resuscitation of residents with do not resuscitate orders in long-term care facilities. Prehosp Emerg Care 2003 Jul/Sep; 7:303-6.
    OpenUrlMedline
  • Comment
  • Share

Your Comment

(will not be published)

More information about text formats

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.