RESUSCITATION DECISIONS ON A DUTCH GERIATRIC WARD

The use of 'do not resuscitate' (DNR) orders was analysed on a Dutch g eriatric ward for a 4-month period. Of 148 admissions, 68 (58%) receiv ed a written DNR order. The use of DNR orders was significantly influe nced by age (>83 years) and the pre-arrest morbidity (PAM) index. PAM> 4 almost always resulted in a DNR order, and PAM score was the only si gnificant contribution to DNR orders under regression analysis. The is suing of DNR orders by geriatric residents was compared with independe nt assessments by the other two health-care team members. In 50% of ca ses where significant comorbidity was zero, at least one of the team s uggested a reason for a DNR order, with a mean of 1.9 reasons. The mos t commonly cited reasons were age (24%), depression (20%) and poor pro gnosis (18%). To evaluate non-patient-related factors involved in DNR decisions, we studied the involvement of patient or family in the deci sion, and the extent of agreement between health-care team members. On ly 3% of patients and 24% of families were involved in the DNR decisio n. Disagreement with the residents' decisions was 20% for staff nurses and 17% for consultants. Physicians use factors besides comorbidity t o make DNR decisions, and further study of such factors is necessary f or the development of standardized DNR policies.