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

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.