PADIO
Physician Action During Illness Onset: Does DNR connote meaning beyond CPR?

Funded by: Hartford/Jahnigen Center of Excellence Faculty Development Award
Project Period: 7/02 - 9/03

Do not resuscitate (DNR) is one type of advance directive that specifies a desire to forego cardiopulmonary resuscitation if a cardiac arrest occurs. Approximately 30% of skilled nursing facility patients have a DNR order and there is concern that being "a DNR patient" is interpreted by nursing home staff to connote a desire for less aggressive care in any clinical decline, not just decline due to cardiopulmonary arrest. This study utilizes the Nursing Home Case-Mix and Quality Demonstration Chart Review Instrument to evaluate care processes among patients with urinary tract infections who are designated DNR compared to those who are not designated DNR. The specific care processes in clued evaluation by a physician and transfer to the hospital. The aim of the study is to determine if DNR orders affect the likelihood that a SNF resident will be evaluated by a physician and/or transferred to a hospital in the event of clinical decline due to a urinary tract infection.

Key Staff: Levy, Eilertsen, Kramer

Abstract:

Levy CL, Do Not Resuscitate orders among nursing home residents in the United States: Prevalence, outcomes and ethnicity of residents designated "DNR." The Gerontological Society of America. San Diego, CA. November 2003.

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