"Do-not-rescuscitate"--Results of introducing a standardized order sheet on documentation quality

Abstract

DNR orders have been used internationally since the 1970 s. Despite the growing importance of patient preference in German law, there is little data on DNR orders in Germany Methods: The prevalence of DNR orders was assessed on the hospital wards. Healthcare were asked about their experiences and opinions in two polls. The charts of all deceased patients were reviewed for DNR notes for 9 month before and after introduction of the new DNR order sheets. The prevalence of DNR orders remained constant at 8% of patients. In 12,4% of these DNR status was not known by the nursing staff. After introduction of the order sheet, the percentage of orders with comprehensive documentation increased from 5.9 to 65.4% of orders (p < 0.001). In the polls the healthcare workers saw a significant improvement in information content of DNR orders after introduction of the new order sheets. The chart review documented an improved documentation of DNR status going up from 28.8 to 40.8% of deceased patients (p < 0.001). The fraction of comprehensive orders increased from 32% to 84.6% (p < 0.001). INTRODUCTION of DNR order sheets in a German hospital lead to objective improvements in the quality of end-of life care documentation while the prevalence of DNR orders remained unchanged.