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Do not hospitalize orders in nursing homes: a pilot study.
John Culberson1, Cari Levy, Larry Lawhorne
1University of Texas Health Science Center, Michael E. DeBakey VAMC, Houston, TX 77030, USA. John.Culberson@med.va.gov
Summary
Most nursing facilities have Do Not Hospitalize (DNH) policies, but physicians write too few DNH orders. Barriers include optimistic prognoses and lack of knowledge, leading to underutilization despite high prevalence.
Area of Science:
- Gerontology
- Health Services Research
- Medical Ethics
Background:
- Do Not Hospitalize (DNH) policies are crucial for end-of-life care in nursing facilities.
- Understanding the prevalence and physician use of DNH orders is essential for improving patient care.
Purpose of the Study:
- To determine the prevalence of DNH policies and orders in nursing facilities.
- To assess physician frequency in writing DNH orders.
- To explore perceptions of DNH order appropriateness and barriers to their use.
Main Methods:
- An online survey was distributed to members of the AMDA Foundation Long-term Care Research Network.
- Participants included nursing facilities, with data collected on DNH policy prevalence and order frequency.
- Qualitative information on the use and perceived appropriateness of DNH orders was gathered.
Main Results:
- 62% of facilities had DNH policies; 80% of physicians wrote DNH orders.
- 77% of respondents believed the number of DNH orders was too few.
- Barriers included overly optimistic prognoses and lack of knowledge about DNH orders.
Conclusions:
- DNH order prevalence in this study exceeds previous national estimates.
- While most facilities have DNH policies, perceived underutilization is high.
- Barriers to DNH order use include family expectations, litigation fears, and staff discomfort.