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DNAR Order Status Changes During Surgical Procedures: Intent Versus Practice.

Lily Johnson, Neil Manago, Michelle Cantillo

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While discussions about do not attempt resuscitation (DNAR) orders are common before surgery, electronic health records often fail to update these orders. This oversight can lead to care gaps, failing to honor patient wishes during anesthesia.

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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.