Do-Not-Resuscitate Orders in the Perioperative Environment: A Multidisciplinary Quality Improvement Project

Area of Science:

• Medical Ethics
• Perioperative Nursing
• Healthcare Quality Improvement

Background:

• Do-not-resuscitate (DNR) orders require adherence to national and institutional guidelines in the perioperative setting.
• Healthcare professionals, particularly perioperative nurses, often lack familiarity with DNR guidelines and their role in order reevaluation.

Purpose of the Study:

• To enhance healthcare providers' compliance with institutional DNR policies.
• To increase nursing involvement in the DNR order reevaluation process.
• To improve communication among providers regarding DNR orders.

Main Methods:

• A multidisciplinary quality improvement project was implemented at a metropolitan community hospital.
• An educational fair was conducted as the primary intervention.
• Surveys assessed knowledge, attitude, comfort, and communication effectiveness before and after the intervention.
• A chart audit evaluated compliance with institutional policy post-intervention.

Main Results:

• Significant improvement in knowledge of DNR orders, institutional policy, and national guidelines (P < .0001).
• Enhanced attitude, comfort levels, and communication effectiveness regarding DNR reevaluation (P < .01).
• A 75% increase in compliance with the institutional DNR policy was observed two months post-intervention.

Conclusions:

• Multidisciplinary educational interventions can effectively improve understanding and management of DNR orders in perioperative care.
• Enhanced provider knowledge and comfort correlate with improved adherence to institutional policies.
• Targeted quality improvement projects are crucial for optimizing patient care and communication surrounding DNR orders.