Nursing home resuscitation policies and practices for residents without DNR orders

Ryden, Muriel B.; Brand, Karen S.; Weber, Eileen; Oh, Heeyoung; Gross, Caroline J.

doi:10.1016/s0197-4572(98)90117-3

Cited by 3 publications

(5 citation statements)

References 11 publications

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“…A majority (96.1%) of deceased residents had DNR orders reflecting preferences to withhold resuscitation in the event of cardiac arrest, and this wish was honored in 100% of cases, but resuscitation was not attempted for six of seven residents with valid full code orders at the time of death. There are a variety of reasons that resuscitation may not have been attempted in this sample of nursing facility residents, including the possibility of facility practices to withhold CPR in unwitnessed arrests because it is so rarely successful . Study findings are also consistent with a research review of 11,976 nursing home deaths in 126 nursing homes that found that CPR was attempted in fewer than 3% of deaths.…”

Section: Discussionsupporting

confidence: 75%

“…There are a variety of reasons that resuscitation may not have been attempted in this sample of nursing facility residents, including the possibility of facility practices to withhold CPR in unwitnessed arrests because it is so rarely successful. 19 Study findings are also consistent with a research review of 11,976 nursing home deaths in 126 nursing homes that found that CPR was attempted in fewer than 3% of deaths. In half of the facilities, CPR was never attempted, which led the authors to conclude that CPR is rarely performed in nursing facilities, regardless of orders or policy.…”

supporting

confidence: 85%

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The Consistency Between Treatments Provided to Nursing Facility Residents and Orders on the Physician Orders for Life-Sustaining Treatment Form

Hickman

Nelson

Moss

et al. 2011

J. Am. Geriatr. Soc.

145

180

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Objectives The POLST (Physician Orders for Life-Sustaining Treatment) program is designed to ensure patients’ treatment preferences are honored by documenting preferences as medical orders. The goal of this study was to evaluate the consistency between treatments provided and POLST orders. Design Retrospective chart abstraction. Setting Stratified, random sample of 90 nursing facilities in Oregon, Wisconsin, and West Virginia. Participants 870 living and deceased nursing facility residents aged 65 and older with a minimum 60-day stay. Measurements Chart data about POLST form orders and related treatments over a 60-day period were abstracted. Decision rules were created to determine whether the rationale for each treatment was consistent with POLST orders. Results Most residents (85.2%) had the same POLST form in place during the review period. A majority of treatments provided to residents with orders for comfort measures only (74.3%) and limited antibiotics (83.3%) were consistent with POLST orders because they were primarily comfort focused rather than life-prolonging. However, antibiotics were provided to 32.1% of residents with orders for no antibiotics. Overall consistency rates between treatments and POLST orders were high for resuscitation (98%), medical interventions (91.1%), antibiotics (92.9%), and modest for feeding tubes (63.6%). In all, POLST orders were consistent with treatments provided 94.0% of the time. Conclusion With the exception of feeding tubes and antibiotic use in residents with orders for no antibiotics, the use of medical treatments was nearly always consistent with POLST orders to provide or withhold life-sustaining interventions. Findings suggest the POLST program is a useful tool for ensuring that the treatment preferences of nursing facility residents are honored.

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Section: Discussionsupporting

confidence: 75%

supporting

confidence: 85%

The Consistency Between Treatments Provided to Nursing Facility Residents and Orders on the Physician Orders for Life-Sustaining Treatment Form

Hickman

Nelson

Moss

et al. 2011

J. Am. Geriatr. Soc.

145

180

View full text Add to dashboard Cite

show abstract

“…At least 97% of dying residents did not undergo CPR, and in about half of facilities surveyed, CPR was never initiated. Yet, in another report, only 30% of facilities surveyed had performed CPR in the past 6 months 48 . Summing the eight studies since 1989 examining success of attempted CPR, only 27 of 800 residents survived to return to the NH, and long‐term outcomes for survivors were bleak 47 .…”

Section: Discussionmentioning

confidence: 99%

“…Yet, in another report, only 30% of facilities surveyed had performed CPR in the past 6 months. 48 Summing the eight studies since 1989 examining success of attempted CPR, only 27 of 800 residents survived to return to the NH, and long-term outcomes for survivors were bleak. 47 Lack of survival after CPR is important to acknowledge and to communicate in discussions with patients or their surrogate decisionmakers.…”

Section: Future Directionsmentioning

confidence: 99%

Effect of Do‐Not‐Resuscitate Orders on Hospitalization of Nursing Home Residents Evaluated for Lower Respiratory Infections

Zweig

Kruse

Binder

et al. 2003

J American Geriatrics Society

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“…There is a large body of literature examining the prevalence of advance directives in general, and do-not-resuscitate (DNR) orders in particular, in nursing homes, 1–5 and the factors that influence patients’ choice of these orders, 6–9 including the way patients are asked about their DNR preferences. 10 There are also studies examining the extent to which physicians discuss these issues with patients and families, and the degree to which nursing home staff follow patient preferences.…”

Section: Introductionmentioning

confidence: 99%

Stability of Cardiopulmonary Resuscitation and Do-Not-Resuscitate Orders Among Long-term Nursing Home Residents

2013

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Background High quality care for long-term nursing home residents should include discussions and follow-up on patients’ end-of-life care wishes. Yet, recent changes to the Minimum Data Set (MDS) data collection exclude this information from routine assessment of patients mandated by the Centers for Medicare & Medicaid Services (CMS), making the provision of high quality end-of-life care less likely. We examined the stability of cardiopulmonary resuscitation (CPR) and do-not-resuscitate (DNR) orders to offer guidance to policy and care practice developments. Methods We examined changes in DNR status of a national long-term care nursing home cohort, following them for 5 years after admission. A competing risk model was estimated to identify covariates predicting changes from CPR to DNR status and vice versa. Results About half the cohort chose DNR at admission and did not change its status. Of those who entered with CPR status, 40% changed to DNR. The most important factors influencing change were hospitalizations and nursing home transfers, followed by race and ethnicity with black race (relative to white) in particular having the largest effect on change. Other individual and nursing home characteristics influenced the likelihood of changing from CPR to DNR as well. Conclusions Long-term nursing home patients who enter with full code CPR have a high probability of changing their status to DNR during their stay. High quality care should offer them the opportunity to revisit their choice periodically, documenting changes in end-of-life choices when they occur, thus ensuring that care will match patients’ wishes. As the MDS plays a prominent role in patients’ care, CMS should consider reinstating information about advance directive in it.

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Nursing home resuscitation policies and practices for residents without DNR orders

Cited by 3 publications

References 11 publications

The Consistency Between Treatments Provided to Nursing Facility Residents and Orders on the Physician Orders for Life-Sustaining Treatment Form

The Consistency Between Treatments Provided to Nursing Facility Residents and Orders on the Physician Orders for Life-Sustaining Treatment Form

Effect of Do‐Not‐Resuscitate Orders on Hospitalization of Nursing Home Residents Evaluated for Lower Respiratory Infections

Stability of Cardiopulmonary Resuscitation and Do-Not-Resuscitate Orders Among Long-term Nursing Home Residents

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