Partial Codes Risk Whole Confusion: Characteristics and Outcomes of Pediatric Partial Code Orders

Area of Science:

• Medical Ethics
• Healthcare Policy
• Clinical Documentation

Background:

• Partial Do-Not-Resuscitate (DNR) orders aim to personalize end-of-life care by specifying limited resuscitative efforts.
• The complexity of these orders can lead to ambiguity, inconsistent care delivery, and ethical dilemmas.

Purpose of the Study:

• To analyze the characteristics and consistency of partial DNR orders within a pediatric oncology and immunology cohort.
• To identify variations, internal conflicts, and documentation issues in partial code status entries.

Main Methods:

• Retrospective review of inpatient partial code order entries over three years at a single institution.
• Categorization of orders based on included/excluded interventions (compressions, defibrillation, intubation, ventilation, medications).
• Analysis of frequency, variation, internal consistency, and alignment with institutional definitions.

Main Results:

• Partial DNR orders comprised 7% of total code status entries (n=15).
• Significant variability in intervention combinations and frequent internal inconsistencies were observed.
• Unclear terminology and documentation issues were common, raising concerns for emergent situations.

Conclusions:

• Partial DNR orders exhibit heterogeneity and a substantial potential for miscommunication.
• While reflecting nuanced patient preferences, they introduce operational and ethical risks to care clarity.
• Findings support institutional review of partial code order policies to enhance patient safety and transparency.