Compliance with DNR policy in a tertiary care center in Saudi Arabia

Do not resuscitate (DNR) is an important aspect of medical practice, although few studies from Arab Muslim countries address this issue. King Abdulaziz Medical City (KAMC), Saudi Arabia has a policy addressing all aspects of patient care at end of life.

To assess compliance of physicians with the current DNR policy.

A cohort study of data prospectively collected from 15/10/2008 through 15/01/2009 for patients where DNR was initiated. Patient charts were followed prospectively to observe DNR documentation completion. Data were analyzed in terms of frequencies and descriptive statistics, and the results expressed as percentages.

DNR was initiated in 65 patients referred to the intensive care unit (ICU): 46.2% females, 53.8% males; age range 19-93 years, mean ± standard deviation (SD) 66.1 ± 16.0 years. DNR was initiated by ICU physician in 80% of cases and by most responsible physician (MRP) in 20% of cases. There was a delay (of more than 48 h) in completing MRP signature in 8 patients (12.3%), and no signature at all by the MRP in 13 patients (20%). Documentation of discussion with the family was absent in 53.8% of cases.

ICU physicians have a role in initiating DNR. Mostly this issue is not addressed on admission. Documentation of DNR once initiated is still not up to the optimum level in 32.3% of cases, mainly due to MRP. Discussion with the patient's family was not well documented in the chart in more than half of cases.