DNAR Order Status Changes During Surgical Procedures: Intent Versus Practice

AbstractIntroduction: The practice of automatic suspension of "do not attempt resuscitation" (DNAR) orders has been abandoned in favor of more nuanced discussions. We sought to assess the practical implementation of DNAR orders at our institution during surgery.

This study conducted a retrospective review of DNAR practices, examining the records of 100 random patients with preexisting DNAR orders prior to surgery. The review documented any changes in DNAR status relative to surgery and then assessed whether the changes in DNAR status were carried forward into the electronic health record (EHR) as updated orders.

The DNAR status of patients with an existing DNAR order was documented as having been rediscussed in 85 percent of cases prior to surgical procedures or interventions requiring general anesthesia. That noted, there was no update in the EHR to the DNAR orders in 88 percent of these cases, suggesting a potential gap in desired care were an event requiring resuscitation to happen while under anesthesia.

Our review indicates that while alterations in the DNAR wishes were often documented relative to anesthesia and surgery, the code status order was not consistently updated, leading to potential gaps in care. The findings underscore the need to standardize processes for updating DNAR status with order sets to ensure that the patient's wishes are accurately reflected during and after anesthesia or surgery.