Healthcare News & Insights

How hospitals must approach DNR orders

Sometimes, giving the best care to hospitalized patients means knowing when to stop interventions to respect their wishes while giving them the support they need as their lives draw to an end. A new study sheds light upon how different facilities handle patients who have do-not-resuscitate (DNR) orders. 

According to an article from futurity.org, researchers from several universities, including Boston University, the University of Michigan and Tufts University, compared the practices of hospitals with high rates of DNR orders to those with low rates of DNR orders to discover if there were any differences in how they treat patients.

Their analysis, published in the Health Services Research journal, found that hospitals that had higher rates of DNR orders for patients ended up using less invasive treatment approaches with these patients, opting to place more of a focus on palliative care that relieves their pain.

Both types of hospitals had similar rates of using CPR on patients who had DNR orders. But other interventions such as mechanical ventilation or dialysis were less likely to be performed on DNR patients at hospitals with higher rates of DNR orders.

Keys to conversations

Researchers speculated that the lower instances of invasive interventions for high-DNR hospitals are likely due to “different hospital practices and local cultural norms for discussing, eliciting and documenting patient wishes” about end-of-life care and treatments designed to keep patients alive.

As the population ages, it’s critical for more facilities to have these conversations with patients – and to get clear guidance from patients on their preferences and wishes, including DNR orders.

If DNR orders aren’t officially noted for the patient, it could cause issues if the person’s condition makes a turn for the worse. And if DNR orders aren’t followed correctly, your hospital could find itself in trouble.

Patients are usually able to speak for themselves as to whether they want a DNR order, and some may have already created an advance directive detailing their preferences. But it may be difficult for providers to broach this topic with patients in the first place.

A study published in the Journal of General Internal Medicine gives several reasons why doctors have trouble discussing DNR orders effectively with patients, including:

  • a hospital culture focused on promoting cutting-edge treatments and life-extending interventions
  • a lack of specific policies that govern DNR discussions with patients, and
  • insufficient provider communication skills.

To remedy these issues, providers need to be mindful about making patients and their families aware of their options when it comes to DNR orders. Conversations about end-of-life preferences should occur as soon as possible, instead of waiting when patients are in grave condition.

In addition, hospitals should have specific standards in place that give providers guidance on how to have these conversations with patients and family members. Providers should make sure they’re giving patients the full picture about how life-sustaining treatments may affect their survival, as well as let them know about any palliative care options.

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