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Deciding About Resuscitation in a Nursing Home Theory and Practice
Author(s) -
Finucane Thomas E.,
Denman Susan J.
Publication year - 1989
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1989.tb02228.x
Subject(s) - medicine , cardiopulmonary resuscitation , do not resuscitate , resuscitation orders , advance care planning , nursing homes , do not resuscitate order , chart , documentation , resuscitation , medical emergency , nursing , family medicine , emergency medicine , palliative care , mathematics , computer science , programming language , statistics
This study examines how plans about cardiopulmonary resuscitation (CPR) were made, what relevant orders were written, and what actual events occurred at the time of death in a nursing home. A chart review of 119 residents who died in a 233‐bed nursing home in 1987 found one who underwent (unsuccessful) CPR. Nine records were unusable. The remaining 109 cases, none of which involved CPR, were studied. Documentation of discussions about CPR between physicians and residents or their surrogates was present in 90 charts. Of 85 residents with cognitive impairment, four were included in the CPR discussion and surrogates were consulted for 66. In 15, no discussion was documented. Of 24 residents without documented cognitive impairment, 11 were consulted. For nine others, surrogates were asked, and in four no discussion was recorded. One resident and three surrogates requested CPR. All others who were asked accepted a do‐not‐resuscitate (DNR) order. For 67 residents DNR orders were written. In six of these cases, physicians wrote the order without documenting consultation with resident or surrogate. For five residents orders to resuscitate (full code orders) were written. For 37 residents no order about CPR was recorded. Of the 42 residents who died without a DNR order, 37 were found dead by nursing staff, but in only one case was a physician contacted urgently. In this nursing home advance planning about CPR was frequently undertaken. Regardless of planning or the orders in the chart, CPR was a rare event.