[Guidelines on do-not-resuscitate orders in Norwegian hospitals]

Area of Science:

• Medical Ethics
• Healthcare Policy
• Clinical Practice Guidelines

Background:

• Norway mandated somatic hospitals to establish do-not-resuscitate (DNR) guidelines following a 2002 directive.
• The directive aimed to standardize practices regarding DNR orders across healthcare facilities.

Purpose of the Study:

• To assess and compare the content of existing do-not-resuscitate (DNR) guidelines in Norwegian hospitals.
• To identify variations and ambiguities in DNR guidelines concerning critical decision-making elements.

Main Methods:

• A survey was distributed to all 31 Norwegian hospital trusts requesting their DNR guidelines.
• Twenty submitted guidelines were analyzed and compared based on 19 predefined criteria.

Main Results:

• Significant variability exists in the content of DNR guidelines, with many lacking clear information on indications, patient/relative involvement, conflict resolution, and advanced directives.
• Key aspects such as patient consent, definitions, and conflict resolution strategies were often ambiguously described or omitted.
• While minor differences were observed between pre- and post-2002 guidelines, there was an increased emphasis on legal provisions.

Conclusions:

• Development of national guidelines is recommended to address ambiguities and ensure consistent application of do-not-resuscitate (DNR) policies.
• Standardized national guidelines would improve clarity and uniformity in DNR practices across Norwegian hospitals.