Objectives: To determine the prevalence and analyze the content of guidelin
es for the use of do-not-resuscitate (DNR) orders in Dutch hospitals.
Design: Cross-sectional descriptive study.
Measurements and Main Results: A questionnaire was mailed to the directors
of patient care at all 143 Dutch hospitals. Directors were asked whether th
eir hospitals had guidelines for the use of DNR orders and to provide copie
s of the guidelines if they did. The content of the guidelines was analyzed
with regard to basic assumptions about nonresuscitation, definitions, pers
ons involved in decision-making, advance directives, starting discussions a
bout nonresuscitation, notation, evaluation, and other aspects. Of the 143
hospital directors surveyed, 95% responded. Sixty percent of the hospitals
had guidelines for the use of DNR orders and provided copies. The assumptio
n "always resuscitate, unless" was mentioned in 66% of guidelines, In 93% i
t was stated that patients should be involved in decision-making about non-
futile resuscitation. In 38% it was stated that in principle, living wills
were respected in cases of incompetence. The role of proxies was mainly to
discuss decisions (58% of guidelines), not to make them. The most frequentl
y mentioned moment for starting a discussion about nonresuscitation was the
onset of clinical deterioration of the patient (41%).
Conclusions: It is promising that 60% of Dutch hospitals have developed gui
delines for the use of DNR orders, However, current guidelines can be impro
ved in many respects.