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Goals of care in a pandemic - our experience and recommendations

ADAMS, Catherine
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 07/2020, vol.60, n°1, p. e15-e17

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Effectiveness of a brief advance directive intervention in primary care - a randomized clinical trial

RANDO-MATOS, Yolanda ; VIVES-ARGILAGOS, Toni ; RODERO-PEREZ, Estrella ; SOLSONA-DIAZ, Lluís ; BALLVE-MORENO, José Luis ; MORENO-FARRES, Noemí ; SORANDO-ALASTRUEY, Rosa ; ADROER-MARTORI, Raquel ; SANFELIU-SOTO, Núria ; ALMEDA-ORTEGA, Jesús
Patient education and counseling, 18/06/2020, Pagination inconnue

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Impact of do-not-resuscitate orders on nursing clinical decision making

ENGELS, Rebecca ; GRAZIANI, Casey ; HIGGINS, Ixavier ; THOMPSON, Jessica ; KAPLOW, Roberta ; VETTESE, Theresa E. ; MASSART, Annie
Southern medical journal, 07/2020, vol.113, n°7, p. 330-336

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Thème : Soins.

TESTAMENT VIE ; INFIRMIERE ; PRISE DECISION ; IMPACT

OBJECTIVES: Code status specifies the action that healthcare providers should take in the event of cardiac arrest. Studies have shown, however, that patients with do-not-resuscitate/do-not-intubate (DNR/DNI) orders have worse outcomes and do not consistently receive the standard of care. Several studies have demonstrated that physicians behave differently toward patients with DNR/DNI orders, but little research exists into whether DNR/DNI status affects the practice of other members of the care team. Our objective was to determine whether code status affects decision making by nursing staff.
METHODS: This was an anonymous, self-administered survey of nurses between April 2018 and March 2019 using SurveyMonkey. The survey contained four previously published clinical vignettes followed by a series of questions regarding specific interventions tailored to reflect nursing escalation of care. Our focus was two local hospitals: one large academic quaternary-referral center and one large community hospital. Registered nurses on medical-surgical units identified based on available unit-specific e-mail listservs from both hospitals were the participants. Nurses in higher-acuity units were excluded.
RESULTS: Nurses are significantly less likely to call rapid response or a physician when a patient undergoes certain changes in clinical status if the patient is labeled as DNR/DNI rather than full code. For all of the vignettes, respondents were less likely to say they would call rapid response or a physician for patients with a DNR/DNI status who developed tachycardia (P < 0.001). Nurses also were less likely to escalate care for patients with DNR/DNI status who developed tachypnea or mental status changes. Nurses were equally likely to call a physician for the development of abdominal pain or new hypotension (P > 0.05). Nurses with >3 years of experience were less likely to escalate care throughout the vignettes (odds ratio <1).
CONCLUSIONS: This study is the first to demonstrate that code status affects decision making by nursing staff. It highlights the limitations that code status designations create with regard to patient care. By acknowledging that patients with DNR/DNI orders receive different care, we can create systems in which patients are treated equally, regardless of their code status.

Origine : PubMed

Is the emergency department an inappropriate venue for code status discussions?

MILLER, Daniel G. ; VAKKALANKA, J. Priyanka ; SWANSON, Morgan B. ; NUGENT, Andrew S. ; HAGIWARA, Yuya
The American journal of hospice and palliative care, 02/07/2020, p. 1-7

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The concerns and experience of decision-making regarding do-not-resuscitate orders among caregivers in hospice palliative care

CHIANG, Ching-Chun ; CHANG, Shu-Chuan ; FAN, Sheng-Yu
American journal of hospice and palliative medicine, 17/06/2020, Pagination inconnue

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Racial differences in do-not-resuscitate orders among pediatric surgical patients in the United States

MPODY, Christian ; HUMPHREY, Lisa ; KIM, Stephani ; TOBIAS, Joseph D. ; NAFIU, Olubukola O.
JOURNAL OF PALLIATIVE MEDICINE, 15/06/2020, Pagination inconnue

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Characterizing patients issued DNR orders who are ultimately discharged alive - a retrospective observational study in Japan

MORI, Tomoari ; MORI, Katsumi ; NAKAZAWA, Eisuke ; BITO, Seiji ; TAKIMOTO, Yoshiyuki ; AKABAYASHI, Akira
BMC palliative care, 09/06/2020, vol.19, n°1, p. 1-8

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Sex differences in "do not attempt resuscitation" orders after out-of-hospital cardiac arrest and the relationship to critical hospital interventions

PERMAN, Sarah M. ; SIRY, Bonnie J. ; GINDE, Adit A. ; GROSSESTREUER, Anne V. ; ABELLA, Benjamin S. ; DAUGHERTY, Stacie L. ; HAVRANEK, Edward P.
Clinical therapeutics, 01/01/2019, vol.41, n°6, p. 1029-1037

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From paper to paperless - do electronic systems ensure safe and effective communication and documentation of DNACPR decisions?

HARRINGTON, Laura ; PRICE, Kathryn ; EDMONDS, Polly
Clinical medicine, 05/2020, vol.20, n°3, p. 329-333

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Perioperative do-not-resuscitate suspension - the patient's perspective

HIESTAND, Debbie ; BEAMAN, Margaret
AORN journal, 01/01/2019, vol.109, n°3, p. 326-334

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Covid-19 - impact on DNR orders in the largest cancer center in Jordan

SHAMIEH, Omar ; RICHARDSON, Kathryn ; ABDEL-RAZEQ, Hikmat ; HARDING, Richard ; SULLIVAN, Richard ; MANSOUR, Asem
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 05/05/2020, p. 1-3

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Covid-19 - campaigner calls for national guidance to stop DNR orders being made without discussion with patients and families

DYER, Clare
BMJ (Clinical research ed.), 07/05/2020, vol.369, p.1

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Denying ventilators to Covid-19 patients with prior DNR orders is unethical

GUTMANN KOCH, Valerie ; HAN, Susie A.
The Hastings Center, 21/04/2020, p. 1-4

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Changes in clinical course before and after do-not-resuscitate order placement in a pediatric intensive care unit setting

ENNAMURI, Sravya ; ABRAMSON, Erika ; MAUER, Elizabeth ; GERBER, Linda M. ; NELLIS, Marianne E.
JOURNAL OF PALLIATIVE MEDICINE, 03/04/2020, Pagination inconnue

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Covid-19 - don’t apply advance care plans to groups of people, doctors’ leaders warn

IACOBUCCI, Gareth
BMJ, 06/04/2020, p. 1

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Cancer patients, physicians, and nurses differ in their attitudes toward the decisional role in do-not-resuscitate decision-making

SALTBÆK, Lena ; MICHELSEN, Hanne M. ; NELAUSEN, Knud M. ; THEILE, Susann ; DEHLENDORFF, Christian ; DALTON, Susanne O. ; NIELSEN, Dorte L.
Supportive care in cancer, 15/04/2020, Pagination inconnue

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The importance of addressing advance care planning and decisions about do-not-resuscitate orders during novel coronavirus 2019 (COVID-19)

CURTIS, J. Randall ; KROSS, Erin K. ; STAPLETON, Renee D.
JAMA, 27/03/2020, p. E1-E2

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Tracey judgement and hospice DNACPR orders - steady as she goes or seismic change?

MACFARLANE, Michael ; SHAYLER, Stephanie ; NELMS, Louisa ; WILLIS, Derek ; WM CARES GROUP
BMJ supportive and palliative care, 12/2019, vol.9, n°4, Pagination inconnue

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Use of combined do-not-resuscitate/do-not intubate orders without documentation of intubation preferences - a retrospective observational study at an academic level 1 trauma center

RUBINS, Jeffrey B.
Chest, 25/02/2020, Pagination inconnue

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Thème : Ethique et déontologie.

TESTAMENT VIE ; ETUDE RETROSPECTIVE ; INFORMATION MALADE ; CONSENTEMENT

BACKGROUND: Combining orders for do-not-resuscitate (DNR) for cardiac arrest with do-not-intubate (DNI) orders into a DNR/DNI code status is not evidence-based practice and may violate patient autonomy and informed consent when providers discuss intubation only in the context of CPR.
RESEARCH QUESTION: How often do providers refer to patients with a DNR order as "DNR/DNI" without documentation of refusal of intubation for non-arrest situations?
STUDY DESIGN AND METHODS: Retrospective observational study of adults (18 years or older) hospitalized in a Level 1 trauma/academic hospital between July 2017 and June 2018 inclusive with DNR orders placed during hospitalization RESULTS: Of 422 hospitalized adults with DNR orders, 261 (61.9%) had code status written in progress notes as DNR/DNI. Providers' use of the term DNR/DNI in progress notes was significantly (OR 2.21 99% CI 1.12 - 4.37) more common on medical hospital services (hospitalist, family medicine, internal medicine) than on non-medical ward services (medical/surgical intensive care units, surgery, psychiatry, neurology services).Of 261 "DNR/DNI"patients, providers did not document informed refusal of intubation for non-arrest situations for 68 (26.0%) of patients. By comparison, of 161 patients where providers documented code status in progress notes as DNR alone, 69 (42.9%) did have documentation of refusal of intubation for non-arrest events. Therefore, if a DNR/DNI code status was used in a non-arrest emergency to determine whether to intubate a patient, 68 (16.1%) of 422 patients could inappropriately be denied intubation without informed refusal (or despite their informed acceptance), and 69 (16.4%) could inappropriately be intubated despite their documented refusal of intubation.
INTERPRETATION: Conflation of DNR and DNI into DNR/DNI does not reliably distinguish patients who refuse or accept intubation for indications other than cardiac arrest, and thus may inappropriately deny desired intubation for those who would accept it, and inappropriately impose intubation on patients who would not.

Origine : PubMed

Timing is everything - early do-not-resuscitate orders in the intensive care unit and patient outcomes

OUYANG, Daniel J. ; LIEF, Lindsay ; RUSSELL, David ; XU, Jiehui ; BERLIN, David A. ; GENTZLER, Eliza ; SU, Amanda ; COOPER, Zara R. ; SENGLAUB, Steven S. ; MACIEJEWSKI, Paul K. ; PRIGERSON, Holly G.
Plos one, 2020, vol.15, n°2, p. 1-12

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