Structured Workflow to Manage Periprocedural Code Status for Patients With Do-Not-Resuscitate Orders

Abstract

Respecting patient wishes regarding resuscitation is fundamental to providing patient-centered care. Despite best practice guidelines for code status management for patients undergoing invasive procedures with existing Do Not Resuscitate (DNR) orders, compliance is low. Our interdisciplinary team created a workflow for code status management of inpatients with active DNR orders undergoing cardiac catheterization (CC) or electrophysiology (EP) procedures. Representatives from nursing, cardiology, surgery, palliative care, internal medicine, and information technology (IT) were involved. We used the workflow for 32 inpatients to temporarily rescind DNR orders for cardiology procedures. Average patient age was 76.6 years. Code status discussion was documented preprocedurally for 78% of patients; however, the documenting clinician varied. Over one third (37.5%) of cases were done with the primary goal of extending the patient's life. Four patients died during the same hospitalization as the procedure. The workflow was well received by stakeholders who appreciated the efficiency and clarity of the process. Interdisciplinary collaboration with key stakeholders and IT support were integral to the success of this intervention.

Keywords: cardiology; code status; do not resuscitate.