Extent of DNR policies varies across healthcare settings

A cross-section random survey of acute care hospitals, psychiatric hospitals, long-term care facilities, and hospices was conducted in 1986 to determine the extent of use, the nature, and the implementation of do-not-resuscitate (DNR) policies. Data also were collected to identify the common problems of implementing DNR policies, as well as how conflicts in the use of DNR orders are resolved. The survey found that 30.7 percent of healthcare organizations have a formal policy, 28 percent have an informal policy, and 41.3 percent have no policy. Formal policies were found in 56.9 percent of acute care and 42.9 percent of hospice care settings, compared with 11.4 percent in psychiatric and 20.1 percent in long-term care settings. Although predictors varied across the four settings studied, formal policies were associated with larger organizations, the use of consultation, accreditation by the Joint Commission on Accreditation of Healthcare Organizations, and the presence of an ethics committee. The recognition of a living will plays a small role in the presence of a formal DNR policy. Given the growing concern of the American public and healthcare organizations over DNR orders, the implications of this study call for careful attention to DNR and related medical and ethical issues and the establishment of policies that clearly delineate when, how, and with whom such issues are discussed and resolved.