[On the topic of do not resuscitate (DNR) orders on intensive care units: an evaluation of the present status on intensive care units of the Innsbruck University clinics].
BACKGROUND
Intensive care physicians are frequently called upon to decide whether intensive care treatment is justified. Critically ill patients with a poor prognosis receive "Do Not Resuscitate (DNR) Orders", which entitles the physician in charge to withhold cardiopulmonary resuscitation in case of cardiac arrest. Guidelines concerning the implementation of DNR orders do not exist for Austrian intensive care units. The aim of this study was to evaluate the different practices of issuing a DNR order in the departments of intensive care medicine at the University Hospital of Innsbruck.


METHODS
Forty-nine physicians working in intensive care units were interviewed about the different procedures in the management of a DNR order. Furthermore, the various answers of senior physicians and assistant physicians were evaluated.


RESULTS
Thirty-nine per cent of the interviewed physicians reported that DNR orders were always issued in writing. According to the answers of 63% of intensive care physicians, the decision to issue a DNR order is usually made by senior physicians. Twenty-nine per cent mentioned that nurses are never included in the decision making process and 6%, that the family is not included in the decision making process. According to 29%, the family is regularly informed about a written DNR order. Twenty per cent of the interviewed physicians reported that the quality of the administration of a written DNR order is very good, 6% that the quality is poor.


CONCLUSIONS
We believe that the unsatisfactory situation in regard of DNR orders is not due to inactivity on the part of physicians, but is more likely a result of the inconclusive and, in part, contradictory legal situation. The physician is compelled to take a major decision within a poorly defined legal situation.
Fries
D
D
Klinische Abteilung für Allgemeine und Chirurgische Intensivmedizin, Universitätsklinik Innsbruck.
Kofler
A
A
Hackl
J
J
Schwamberger
H
H
Klingler
A
A
Antretter
V
V
Schobersberger
W
W
D000328:Adult; D001291:Attitude of Health Personnel; D001317:Austria; D003657:Decision Making; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000331:legislation & jurisprudence*; D007872:Legal Guardians; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000331:legislation & jurisprudence; D011785:Quality Assurance, Health Care / Q000331:legislation & jurisprudence; D016414:Resuscitation Orders / Q000331:legislation & jurisprudence*