CRNA awareness and experience with perioperative DNR orders

Despite 2 decades of experience with do-not-resuscitate (DNR) orders, some controversy regarding their use still remains. By using a mailed questionnaire to a randomized sample of 500 active members of the American Association of Nurse Anesthetists, the present study explored the awareness, experiences, and opinions of nurse anesthetists regarding DNR orders for patients undergoing surgery. The purpose of the study was to evaluate the need for further education and discussion in this area. Of the 228 (45.6%) respondents, more than half had DNR policies at their facility, while the remainder reported no policy or were unsure whether a policy existed. Of those having policies, 67.2% indicated a policy of routine DNR suspension, approximately 20% had a policy of reevaluation, and the remainder were unsure of the type of policy. However, when asked what type of policy respondents thought was most appropriate, 54.2% favored a policy of reviewing the DNR order, with 95% advocating patient involvement in the reevaluation. Moreover, almost 90% of responding CRNAs indicated they would discuss DNR status with the patient before surgery. When a patient with a DNR order subsequently had an intraoperative cardiac event, 13% initiated resuscitation. Responding to a hypothetical question involving a patient with a DNR order, 42% to 48% of respondents indicated they would initiate resuscitative measures in such a situation depending on the cause of arrest.