TRIAD XII: Are Patients Aware of and Agree With DNR or POLST Orders in Their Medical Records
| Autor: | Nathan Cook, Timothy E. Cooney, Lynn Weissert, Mary Lynn Lewis, Ferdinando L. Mirarchi, Kristin Juhasz, Tammy Kordes, Brandon Intrieri, Justin Puller |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
end of life medicine.medical_specialty Leadership and Management medicine.medical_treatment Medical information Medical Records 03 medical and health sciences Patient safety 0302 clinical medicine Interquartile range Health care Humans Medicine 030212 general & internal medicine Cardiopulmonary resuscitation advance care planning Aged Resuscitation Orders POLST Terminal Care living will business.industry 030503 health policy & services Medical record Public Health Environmental and Occupational Health Original Articles POLST like Patient preference Living Wills Hospital admission Emergency medicine Female DNR 0305 other medical science business |
| Zdroj: | Journal of Patient Safety |
| ISSN: | 1549-8425 1549-8417 |
| DOI: | 10.1097/pts.0000000000000631 |
| Popis: | Objective The aim of the study was to determine (1) whether do-not-resuscitate (DNR) orders created upon hospital admission or Physician Orders for Life-Sustaining Treatment (POLST) are consistent patient preferences for treatment and (2) patient/health care agent (HCA) awareness and agreement of these orders. Methods We identified patients with DNR and/or POLST orders after hospital admission from September 1, 2017, to September 30, 2018, documented demographics, relevant medical information, evaluated frailty, and interviewed the patient and when indicated the HCA. Results Of 114 eligible cases, 101 met inclusion criteria. Patients on average were 76 years old, 55% were female, and most white (85%). Physicians (85%) commonly created the orders. A living will was present in the record for 22% of cases and a POLST in 8%. The median frailty score of “4” (interquartile range = 2.5) suggested patients who require minimal assistance. Thirty percent of patients requested cardiopulmonary resuscitation and 63% wanted a trial attempt of aggressive treatment if in improvement is deemed likely. In 25% of the cases, patients/HCAs were unaware of the DNR order, 50% were unsure of their prognosis, and another 40% felt their condition was not terminal. Overall, 44% of the time, the existing DNR, and POLST were discordant with patient wishes and 38% were rescinded. Of the 6% not rescinded, further clarifications were required. Discordant orders were associated with younger, slightly less-frail patients. Conclusions Do-not-resuscitate and POLST orders can often be inaccurate, undisclosed, and discordant with patient wishes for medical care. Patient safety and quality initiatives should be adopted to prevent medical errors. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|