Documentation of do-not-resuscitate orders in an Irish hospital

Abstract

Background: Some studies have suggested that do-not-resuscitate (DNR) decisions are often documented poorly in European countries.

Aim: To examine the use and documentation of DNR orders in a large Irish teaching hospital.

Methods: Resuscitation status of all inpatients on a single day was determined using interviews with nursing staff and examination of the nursing and medical case notes.

Results: Seventeen (3.5%) of 485 patients were identified as not for resuscitation. There was written confirmation of the DNR order in the nursing notes for 14 (82%) and in the medical notes for 15 (88%) patients; in two cases, it was reported that doctors were reluctant to write down the agreed decision. Documentation of DNR orders was by consultant (7), registrar (7) and intern (1). Discussion with patient (2), family (10) or both (1) was recorded in 14 cases.

Conclusion: The majority of DNR orders were clearly documented by senior doctors and had been discussed with the patient or with the relatives. A number of problems were identified that might be avoided by development of guidelines regarding use and documentation of DNR orders.