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James A. Mittelberger, MD, MPH; Bernard Lo, MD; Diane Martin, PhD; Richard F. Uhlmann, MD, MPH

Arch Intern Med. 1993;153(2):228-232.

Abstract
Background
Serious problems exist with respect to documentation of do not resuscitate (DNR) orders. We studied the impact of a procedure-specific DNR order form on documentation of these orders.

Methods
We prospectively compared DNR chart documentation during a 3-month period before and after implementation of a procedure-specific DNR order form.

Results
The order form was used in 41 (93%) of 43 charts after its implementation. Documentation of attending physician agreement with the DNR order form increased from 30 of 34 charts in which the order form was used). The number of orders where it was uncertain whether at least one component of acute cardiopulmonary life support—related procedures was to be performed decreased from 30 (88%) of 34 charts to three (7%) of 43 charts. The order form had no measurable impact on documentation of DNR discussion. Only 25% of the charts had any discussion of the risks and benefits of CPR.

Conclusions
A procedure-specific DNR order form can improve documentation of DNR decisions. The reduction of uncertainty in these orders about the use of specific procedures can prevent errors in patient care.

(Arch Intern Med. 1993;153:228-232)

Author Affiliations
From the University of California, San Francisco School of Medicine (Drs Mittelberger and Lo); Department of Community Medicine, University of Washington School of Public Health (Dr Martin), and Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington School of Medicine, Seattle (Dr Uhlmann).

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