The over-interpretation of DNAR

The over-interpretation of DNAR

Stewart M; Baldry C

Clinical Governance

2011

Medical Sciences; Studies; Emergency medical care; Business And Economics--Management; Duty of care; Patients rights; Right to Die

The purpose of this paper is to investigate the impact of a Do Not Attempt Resuscitation (DNAR) order on subsequent decision making relating to the clinical care of the patient. The approach taken was a questionnaire based on a hypothetical clinical case, completed by medical and nursing staff of all grades in general medical, surgical, and orthopaedic wards. There is a reduction in the urgency attached to reviewing a deteriorating patient following institution of a DNAR order. Many doctors and nurses will not perform a range of interventions in the patient with a DNAR order in place. Confusion exists regarding whether an apnoeic, peri-arrest patient should be ventilated when a DNAR order is in place. This was a single-centre study, looking at a hypothetical situation. Further studies at more centres, and investigating different designs of DNAR form, would clarify the best format for these to take. A DNAR statement may often be interpreted as limiting other forms of care. This is more likely amongst more junior doctors and nursing staff, who are frequently the first line of assessment of these patients. More explicit DNAR forms may be advisable to confirm what treatments are to be continued. This paper demonstrates that DNAR decisions are taken as a surrogate marker for limiting other forms of care, and that this extends to medical and nursing staff at all grades.

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