Do-not-resuscitate orders in Swedish medical wards

In a nation-wide survey, procedures related to do-not-resuscitate (DNR) orders in Swedish medical wards were investigated by means of a questionnaire given to internists-in-charge. The response rate was 89% (286 out of 323), of whom all but 2% (seven individuals) stated that DNR orders were used in their wards. The most common procedure was an oral direction to the nurse, who documented the order in the nurses' day-to-day work sheet. The DNR orders were signed by 28% of the physicians. A wide range of symbols and code words were used, and there was considerable disagreement regarding the meaning of a DNR order. Such orders were often associated with withdrawal and withholding of life-sustaining treatments other than cardiopulmonary resuscitation. Most physicians stated that they never discuss DNR order with the patients, and that only in a minority of DNR decisions do they involve family members. There was considerable conflict with regard to DNR ordering procedures not only between internists in different hospitals, but also within individual hospitals.