DNR Order Does Not Affect Overall Quality of Care in ICU Says Study Presented at Congress of Society of Critical Care Medicine

2/1/2003

From: Katie Lundberg of the Society of Critical Care Medicine, 847-827-7502 or 210-582-7039 (on site) SAN ANTONIO, Texas, Feb. 1 -- The level of care in the intensive care unit (ICU) is not impacted by a do-not- resuscitate (DNR) order, according to a preliminary study released today at the 32nd Critical Care Congress of the Society of Critical Care Medicine. "Many end-of-life papers are partially based on the assumption that a DNR order will decrease overall level of care. However, we were not surprised to find that patient care did not diminish following a DNR order in our mixed medical and surgical ICU," says Paul B. Tessmann, a fourth year medical student at the University of North Dakota School of Medicine and Health Sciences. "Our research shows that physicians in this regional referral ICU continued to write orders that provided for a high quality of care despite DNR status, and that nurses continued to deliver a high level of care to all patients. This should reassure patients who come to this center that if a DNR order is agreed upon, it will not decrease overall level of care," explained Tessmann. Tessmann is the lead author of the study, "Effect of a Do Not Resuscitate Order on The Level of Care in an Intensive Care Unit," presented today at the Critical Care Congress at the Henry B. Gonzalez Convention Center in San Antonio. "People are concerned that once a DNR order is written the level of care will drop off. The public needs to understand that a DNR order comes into play only in the event of cardiac arrest or life-threatening arrhythmia, which requires a life-saving combination of medications, defibrillation and cardiopulmonary resuscitation. In the absence of such an event, such an order should not affect any aspects of care," comments Tessmann. The researchers reviewed 42 charts of patients who were admitted to the intensive care unit at a university-affiliated, community-based teaching hospital to determine if a DNR order affects the level of patient care. The therapeutic intensity scoring system (TISS-28) scores were tabulated for the 24 hours before and after a code change. According to background information in the abstract, current literature says patients and caregivers are concerned about agreeing to the writing of end-of-life orders because of confusion over the meaning of "do not resuscitate." There is concern that a DNR order will terminate all treatments. "It is important that the meaning of `do not resuscitate' and its implications are explained to patients and their families when physicians are discussing the writing a DNR order," Tessmann concludes. Another ramification of the study is the finding that TISS-28 can be used to review ICUs. "We encourage other institutions to apply this tool to evaluate performance," says Tessmann. Because TISS-28 scores were studied for only 48 hours, the researchers recommend a longer study period for each patient. Until then, Tessmann cautions against generalization of these initial findings. The Society of Critical Care Medicine is the leading professional organization dedicated to ensuring excellence and consistency in the practice of critical care medicine. With over 10,000 members worldwide, the Society is the only professional organization devoted exclusively to the advancement of multidisciplinary, multiprofessional intensive care through excellence in patient care, professional education, public education, research and advocacy. Members of the Society include intensivists, critical care nurses, critical care pharmacists, clinical pharmacologists, respiratory care practitioners and other professionals with an interest in critical care, which may include physician assistants, social workers, dieticians, and members of the clergy.