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Decisions not to resuscitate in a Swedish university hospital
H Friberg1, A Adolfsson, D Lundberg
1Department of Anesthesiology, Lund University Hospital, Sweden.
Insights
Decisions to withhold cardiopulmonary resuscitation (CPR) are often not documented, even when medically appropriate. Patient and family involvement in these critical do-not-resuscitate decisions remains limited in Swedish hospitals.
Area of Science:
- Medical Ethics
- Clinical Practice
- Patient Care
Background:
- Cardiopulmonary resuscitation (CPR) can be life-saving but may be inappropriate if used indiscriminately.
- Lack of clear guidelines for do-not-resuscitate (DNR) orders in Sweden.
- Need to evaluate the current practice of DNR orders in a university hospital setting.
Purpose of the Study:
- To assess the utilization and documentation of do-not-resuscitate orders.
- To identify discrepancies in the perception of CPR appropriateness.
- To evaluate patient and family involvement in DNR decisions.
Main Methods:
- Cross-sectional study of 220 adult inpatients across medical, surgical, and neurological wards.
- Interviews conducted with responsible physicians and nurses on a specific day.
- Review of medical records for documented do-not-resuscitate orders.
Main Results:
- Discrepancies noted between doctors' and nurses' views on CPR appropriateness.
- CPR deemed inappropriate for 20% of patients (45/220).
- Only 24 of these 45 patients had a written DNR order, often using coded language; patient/family involvement was minimal.
Conclusions:
- Decisions to refrain from resuscitation are frequently not made, even when medically and ethically indicated.
- The use of coded information for DNR status is still prevalent.
- Limited involvement of patients and their relatives in the DNR decision-making process.
Background:
Cardiopulmonary resuscitation (CPR) has the potential to save many lives. Used indiscriminately though, it may be harmful and not in the best interest of the patient. An advance directive to refrain from resuscitation in selected patients is probably not uncommon in Sweden, but guidelines ruling this are still generally lacking. This study was performed to evaluate the use and documentation of do-not-resuscitate orders in a Swedish university hospital.
Methods:
Adult inpatients at 7 medical, 3 surgical and 2 neurological wards, a total of 220, were investigated on one specific day by interviewing the physicians and nurses responsible for their care.
Results:
We found a discrepancy in doctors' and nurses' perception concerning the appropriateness of CPR in selected patients. CPR was judged by doctors to be inappropriate for 45 patients (20%). Out of these 45 patients, only 24 had a written do-not-resuscitate order in their medical record, in most cases noted as a code word or sign only. Rarely were the patient or his/her relatives involved in the decision-making process.
Conclusion:
We conclude that a decision to refrain from resuscitation is often not made, even when considered medically and ethically justifiable. Also, the use of coded information as a sole indicator for a patient not to be resuscitated is still common practice. The patient or his/her relatives are rarely involved in this decision.