Difficulties in the administration of the Do Not Resuscitate (DNR)-Order at intensive care units: An evaluation of the present situation at the intensive care units of the University Hospital of Innsbruck
D. Fries et al., Difficulties in the administration of the Do Not Resuscitate (DNR)-Order at intensive care units: An evaluation of the present situation at the intensive care units of the University Hospital of Innsbruck, WIEN KLIN W, 111(4), 1999, pp. 161-168
Introduction: Intensive care physicians are frequently called upon to decid
e whether intensive care treatment is justified. Critically ill patients wi
th a poor prognosis receive "Do Not Resuscitate (DNR) Orders", which entitl
es the physician in charge to withhold cardiopulmonary resuscitation in cas
e of cardiac arrest. Guidelines concerning the implementation of DNR orders
do not exist for Austrian intensive care units. The aim of this study was
to evaluate the different practices of issuing a DNR order in the departmen
ts of intensive care medicine at the University Hospital of Innsbruck.
Methods: Forty-nine physicians working in intensive care units were intervi
ewed about the different procedures in the management of a DNR order. Furth
ermore, the various answers of senior physicians and assistant physicians w
ere evaluated.
Results: Thirty-nine per cent of the interviewed physicians reported that D
NR orders were always issued in writing. According to the answers of 63% of
intensive care physicians, the decision to issue a DNR order is usually ma
de by senior physicians. Twenty-nine per cent mentioned that nurses are nev
er included in the decision making process and 6%, that the family is not i
ncluded in the decision making process. According to 29%, the family is reg
ularly informed about a written DNR order. Twenty per cent of the interview
ed physicians reported that the quality of the administration of a written
DNR order is very good, 6% that the quality is poor.
Conclusion: We believe that the unsatisfactory situation in regard of DNR o
rders is not due to inactivity on the part of physicians, but is more likel
y a result of the inconclusive and, in part, contradictory legal situation.
The physician is compelled to take a major decision within a poorly define
d legal situation.