Pediatric Perioperative DNR Orders: A Case Series in a Children's Hospital

Title

Pediatric Perioperative DNR Orders: A Case Series in a Children's Hospital

Creator

Brown SES; Antiel RM; Blinman TA; Shaw S; Neuman Mark D; Feudtner C

Publisher

Journal of Pain and Symptom Management

Date

2019

Subject

Palliative Care; Do-Not-Resuscitate Orders; End of Life; Palliative Surgery; Perioperative Guideline Adherence

Description

Context Do-not-resuscitate (DNR) orders are common among children receiving palliative care, who may nevertheless benefit from surgery and other procedures. Although anesthesia, surgery, and pediatric guidelines recommend systematic reconsideration of DNR orders in the perioperative period, data regarding how clinicians evaluate and manage DNR orders in the perioperative period is limited. Objectives Evaluate perioperative management of DNR orders at a tertiary care children�s hospital. Methods We reviewed electronic medical records for all children with DNR orders in place within 30 days of surgery at a tertiary care pediatric hospital from 2/1/2016 � 8/1/2017. Using standardized case report forms, we abstracted the following from physician notes: (A) patient/family wishes with respect to the DNR, (B) whether pre-operative DNRs were continued, modified, or suspended during the perioperative period, and (C) whether life threatening events occurred in the perioperative period. Based on data from these reports, we created a process flow diagram regarding DNR order decision making in the perioperative period. Results Twenty-three patients aged six days to 17 years had a DNR in place within 30 days of 29 procedures. No documented systematic reconsideration took place for 41% of procedures. DNR orders were modified for two (7%) procedures, and suspended for fifteen (51%). Three children (13%) suffered life threatening events. We identified four time points where systematic reconsideration should be documented in the medical record, recommended personnel, and important discussion points at each time point. Conclusion Opportunities exist to improve how DNR orders are managed during the perioperative period.

Rights

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Citation List Month

April 2019 List

Collection

Citation

Brown SES; Antiel RM; Blinman TA; Shaw S; Neuman Mark D; Feudtner C, “Pediatric Perioperative DNR Orders: A Case Series in a Children's Hospital,” Pediatric Palliative Care Library, accessed October 21, 2021, https://pedpalascnetlibrary.omeka.net/items/show/16117.

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