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'Do not resuscitate': How? why? and when?
1Intensive Care Unit, Park Royal Centre for Mental Health, London, UK.
Objective:
The main objective was to discover who had 'Do Not Resuscitate' (DNR) status, why, how, when and by whom these decisions were made.
Design, Setting And Patients:
The medical and nursing notes of all inpatients (139) (age range 16-100 years) in an inner city district general hospital on a single day were examined to determine the resuscitation status, age, sex, and diagnosis of each patient.
Result:
A decision not to resuscitate had been taken in 28 (20%) of the cases. 'Do Not Resuscitate' (DNR) patients were significantly older and more likely to suffer from malignant and cardiorespiratory disease. Patients with dementia and other psychiatric disorders were not significantly more often labelled DNR. Evidence of consultation for these decisions was lacking and the recording erratic.
Conclusions:
(1) There is a great need to devise and implement comprehensive guidelines. (2) There is need for appropriate and comprehensive documentation outlining the reasons why and how the decision was taken, who was consulted and review date. (3) This is an important area for audit.