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Do‐Not‐Hospitalize Orders in Nursing Homes: “Call the Family Instead of Calling the Ambulance”
Author(s) -
Cohen Andrew B.,
Knobf M. Tish,
Fried Terri R.
Publication year - 2017
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/jgs.14879
Subject(s) - medicine , nursing , focus group , nursing homes , coding (social sciences) , qualitative research , grounded theory , multidisciplinary approach , medical emergency , statistics , mathematics , marketing , sociology , business , social science
Objectives To determine how do‐not‐hospitalize ( DNH ) orders are interpreted and used in nursing homes ( NH s) once they are in place. Design Qualitative study using in‐depth semi‐structured interviews performed from December 2013 to April 2014. Setting Eight skilled nursing facilities in Connecticut that ranked in the top 10% or bottom 10% in hospitalization rates from 2008 to 2010. Participants Nursing facility staff members (N = 31). Measurements A multidisciplinary team performed qualitative content analysis. The constant comparative method was used to develop a coding structure and identify themes. Results DNH orders were uncommon at low‐ and high‐hospitalizing facilities. Participants reported that they did not interpret these orders literally. A DNH order was not a prohibition against hospitalization but was understood to have a variety of exceptions. These orders functioned primarily as a signal that hospitalization should be questioned and discussed with the family when an acute event occurred. Conclusion In‐the‐moment discussions about hospitalization are still necessary even when a DNH order is in place. Work to reduce potentially burdensome NH –hospital transfers needs to focus not just on eliciting preferences in advance, but also on preparing residents and their families to make the best decisions about hospitalization when the time comes.