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The introduction and auditing of a formal do not resuscitate policy.

AIMS
To introduce, to assess the use of and the staff understanding of a do not resuscitate policy.


METHODS
A policy was developed with legal, medical, nursing and ethical input. Two distinct methods for a do not resuscitate order were allowed. The first method is where the patient requests a do not resuscitate order. The second is the medically indicated do not resuscitate order. The policy was trialed on two floors at Dunedin Hospital and an audit performed. Information was collected on patients receiving do not resuscitate orders. The notes of all patients dying on these floors were reviewed. A questionnaire was sent to clinical staff working on the trial floors which included questions on their understanding of issues related to do not resuscitate orders.


RESULTS
86% of deaths had a do not resuscitate order, 26% in accordance with the formal policy. Thirty percent of the time there was no record of a discussion of the do not resuscitate order with the patient or their family. Problems identified by staff included difficulty with raising and discussing these orders with patients and their families. Staff misunderstanding of consent and responsibility for treatment decisions for mentally competent and incompetent patients was common.


CONCLUSIONS
There is a need for further staff education and discussion of the issues surrounding do not resuscitate orders. Discussion with patients and their families could be improved.