Audit of Do-Not-Resuscitate Order Status of Patients in a Homecare and In-Patient Palliative Care Service

Abstract

Do-Not-Resuscitate (DNR) orders vary in prevalence among palliative care services.  Some hospice programs require patients to have completed DNR forms prior to service admission.  It was our intent to investigate the rates of DNR orders in a multi-tiered, multi-service palliative care program and to compare these rates with ideals and goals of staff.  We performed an audit, blinded to patient caregiver, of charts for patients on homecare and in-patient services.  We then constructed a questionnaire to investigate staff perceptions and goals for DNR status of patients in their care.  After reviewing 87 charts, we determined the prevalence of DNR status to be 48%.  From the completed questionnaires, staff estimated (mean [95% CI]) that 72% [58, 86] of patients under their care had DNR orders.  Also, staff felt that 96% [90, 101] of patients under their care should have DNR orders in place.  There was therefore discrepancy between the prevalence, perceived prevalence, and desired prevalence of DNR orders in this palliative care service.  Following this investigation, the lead author chaired an open forum with staff to address these discrepancies.  Staff felt a new method of tracking DNR status as well as a more structured timeline to address DNR status with patients on service is warranted.  A follow-up study to evaluate improvements spawned from this audit would indeed be interesting.