DNAR Order Status Changes During Surgical Procedures: Intent Versus Practice

Area of Science:

• Medical Ethics
• Anesthesiology
• Health Informatics

Background:

• The practice of automatically suspending "do not attempt resuscitation" (DNAR) orders during surgery has shifted towards more individualized discussions.
• Ensuring patient wishes regarding resuscitation are respected during medical procedures is a critical ethical and clinical consideration.

Purpose of the Study:

• To evaluate the implementation and electronic health record (EHR) updating of DNAR orders in patients undergoing surgery at a specific institution.
• To identify potential discrepancies between documented patient wishes and actual orders in the EHR during the perioperative period.

Main Methods:

• A retrospective review of 100 random patients with pre-existing DNAR orders prior to surgery was conducted.
• Data collected included documentation of DNAR status discussions relative to surgery and subsequent updates in the EHR.

Main Results:

• DNAR status was rediscussed in 85% of cases before surgical procedures requiring general anesthesia.
• However, the EHR was not updated with the DNAR status in 88% of these cases, indicating a significant gap in order accuracy.
• This suggests a potential for care to deviate from patient preferences if resuscitation is needed under anesthesia.

Conclusions:

• Alterations in DNAR wishes are frequently documented around anesthesia and surgery, but the corresponding code status orders in the EHR are not consistently updated.
• This inconsistency creates potential gaps in care, risking the failure to adhere to patients' stated wishes.
• Standardizing processes for updating DNAR status within order sets is crucial to ensure accurate reflection of patient preferences during and after surgical interventions.