Withholding cardiopulmonary resuscitation: one hospital's policy

We investigated prospectively the current "do not resuscitate" policy at the Royal Adelaide Hospital, to assess the success of the policy in limiting cardiopulmonary resuscitation and to review how orders to withhold resuscitation were documented. We studied the medical records of 272 patients who died in hospital wards over a three-month period in 1987, and found that in 61% of patients a "do not resuscitate" order had been written, including in 75% of those patients who died with a malignant disease. "No resuscitation" was the most common wording, which occurred in 23% of the orders, whereas only 16% of orders used the terminology "for ordinary measures"--the wording that is recommended in the hospital policy. We conclude from this study of hospital deaths that "do not resuscitate" orders are used frequently and serve to limit the use of cardiopulmonary resuscitation in patients who die in hospital, but are documented without regard to official policy.