Do-not-resuscitate orders

Do-Not-Resuscitate (DNR) orders were audited in October and December 1989 at the teaching hospital of the University of Florida College of Medicine in Gainesville. October audit results were presented at a medical staff meeting in November to determine if education would improve compliance. There were 22 DNR orders in October, 17 (77%) were out of compliance with hospital policy due to failure to obtain written consultation from a second attending. Although not required by hospital policy, there were 11 instances (50%) in which patients (or families) were required to provide written documentation of their wishes (a living will) before the attending would write the order. There were 22 DNR orders in December, eight (36%) were out of compliance due to failure to obtain written consultation from a second attending. There were no instances of attendings' requiring patients (or families) to provide written documentation of their wishes. Education improved compliance with hospital DNR policy, but physicians were still reluctant to obtain consultation from colleagues.