Hanne Irene Jensen PhD, MHSc, CCN (is Professor, Departments of Anesthesiology and Intensive Care, Lillebaelt Hospital (Vejle and Kolding), University Hospital of Southern Denmark, and Department of Regional Health Research, University of Southern Denmark.), Hanne Andersen MPG, RN (is Nursing Director, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark.), Helen Bruun MHSc, RN (is Quality Coordinator, Department of Medicine, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark. Please address correspondence to Hanne Irene Jensen)
{"title":"Improving Awareness and Communication of Do Not Resuscitate Orders During Transitions of Care","authors":"Hanne Irene Jensen PhD, MHSc, CCN (is Professor, Departments of Anesthesiology and Intensive Care, Lillebaelt Hospital (Vejle and Kolding), University Hospital of Southern Denmark, and Department of Regional Health Research, University of Southern Denmark.), Hanne Andersen MPG, RN (is Nursing Director, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark.), Helen Bruun MHSc, RN (is Quality Coordinator, Department of Medicine, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark. Please address correspondence to Hanne Irene Jensen)","doi":"10.1016/j.jcjq.2025.06.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Do not resuscitate (DNR) orders are not always documented at transitions of care, which may lead to inappropriate resuscitation attempts. The objectives of this study were (1) to investigate the challenges in ensuring that all staff are aware of patients’ DNR orders, (2) to examine documentation of DNR orders at transitions of care, and (3) to improve knowledge about DNR orders in institutions and at transitions of care.</div></div><div><h3>Methods</h3><div>This intervention initiative with pre- and post-measurements (2020 and 2023) involved hospital departments and nursing homes in Denmark. The intervention consisted of a practical instruction brochure and an end-of-life presentation. The measurements included audits of resuscitation attempts and of DNR order documentation at transitions of care. Furthermore, the participating institutions completed an electronic survey on perceived challenges.</div></div><div><h3>Results</h3><div>Thirty nursing homes and eight hospital departments participated in pre-measurement, 20 nursing homes and seven hospital departments participated in post-measurement, and 17 to 20 sites were included in paired analyses. The number of inappropriate resuscitation attempts was identical at pre- and post-measurements (none in nursing homes and five at the hospital). Correct documentation in nursing reports at hospital discharge increased from 32% to 53% (<em>p</em> = 0.003). Participating units that did not perceive challenges in ensuring knowledge of DNR orders increased from 10% to 48% (<em>p</em> < 0.001). At post-measurement, more than 80% of participating units had worked with models to ensure awareness of DNR orders and inclusion of DNR orders at transitions of care.</div></div><div><h3>Conclusion</h3><div>Participants experienced a significant increased focus on DNR orders in their own departments. Likewise, a significant increase in communication of DNR orders at transitions of care was found.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 9","pages":"Pages 574-581"},"PeriodicalIF":2.4000,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553725025001473","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Do not resuscitate (DNR) orders are not always documented at transitions of care, which may lead to inappropriate resuscitation attempts. The objectives of this study were (1) to investigate the challenges in ensuring that all staff are aware of patients’ DNR orders, (2) to examine documentation of DNR orders at transitions of care, and (3) to improve knowledge about DNR orders in institutions and at transitions of care.
Methods
This intervention initiative with pre- and post-measurements (2020 and 2023) involved hospital departments and nursing homes in Denmark. The intervention consisted of a practical instruction brochure and an end-of-life presentation. The measurements included audits of resuscitation attempts and of DNR order documentation at transitions of care. Furthermore, the participating institutions completed an electronic survey on perceived challenges.
Results
Thirty nursing homes and eight hospital departments participated in pre-measurement, 20 nursing homes and seven hospital departments participated in post-measurement, and 17 to 20 sites were included in paired analyses. The number of inappropriate resuscitation attempts was identical at pre- and post-measurements (none in nursing homes and five at the hospital). Correct documentation in nursing reports at hospital discharge increased from 32% to 53% (p = 0.003). Participating units that did not perceive challenges in ensuring knowledge of DNR orders increased from 10% to 48% (p < 0.001). At post-measurement, more than 80% of participating units had worked with models to ensure awareness of DNR orders and inclusion of DNR orders at transitions of care.
Conclusion
Participants experienced a significant increased focus on DNR orders in their own departments. Likewise, a significant increase in communication of DNR orders at transitions of care was found.