Decision to refrain from resuscitation in hospitals

Abstract

In 2009, the Norwegian Directorate of Health published the national guidelines 'Decision-making processes in the limitation of life-prolonging treatment' (1). It is not known whether the recommendations in the guidelines are followed in clinical practice. The purpose of this study was to investigate the decision-making process when a DNR order has been issued to refrain from resuscitation and the patient group for whom such an order is made. The patients studied were hospitalised in the medical ward of a local hospital in 2012. Patients with a DNR order were identified through searches in 'critical information' in the DIPS patient record system. The study was conducted by means of a retrospective review of patient records with a follow-up time of two years. When competence to give informed consent was not recorded in the patient records, this was assessed based on other information in the records. A total of 363 out of 12 522patients hospitalised in 2012 were registered with DNR orders. Their average age was 82.5 years. Hospital mortality was 37% and 30-day mortality 66%. The DNR order was based on the patient's own wishes in 116 out of 363patients. Altogether 64% of these were women. Competence to give informed consent was never explicitly noted in the patient records. A total of 27% of the patients who were assessed as competent to give informed consent were not involved in the decision. Patients with DNR orders are characterised by advanced age, mortality and morbidity. Clearer documentation of the assessment of competence to give informed consent, as well as better involvement of the patient, are necessary.