title: Discussing and documenting (do not attempt) resuscitation orders in a Dutch Hospital: a disappointing reality.
abstract: OBJECTIVE
  To determine whether the introduction of a patient information sheet about do not attempt resuscitation (DNAR) orders and personal motivation of the medical staff results in an improvement in the documentation of the DNAR orders in the medical records.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  The medical records for all hospital admissions during February 2005 were checked for age, sex, admission time, admitting specialty, admission type (acute or planned), death, documentation of the DNAR order on the admission form, and if this order was complied with and under whose initiative the order was implemented or not. These data were compared to the medical records from 2 years earlier.
  
  
  RESULTS
  In 2005, 119 (9.3%) medical records a DNAR order was found, compared to 10.7% in 2003. In the 43 patients who died DNAR orders were documented more often (18.6%) than in other patients (9%). The DNAR order was written more frequently for patients who were older (46.5 years versus 67.5 years), had a longer hospital admission period (4.2 versus 12.4 days) and for acute admissions. No difference was found for sex. Of the specialties with more than 10 admissions a month, the most frequently written DNAR orders came from internal medicine (36%) and pulmonology (31%); the least from cardiology (2.2%) and thoracic surgery (0%). In 9 of the 119 (7.6%) the DNAR orders were explained, most were initiated by the doctor (7), 1 by the patient an 1 by the family.
  
  
  CONCLUSIONS
  Giving patients more information about DNAR orders and motivating medical staff personally does not influence the documentation of DNAR orders. If documented, it occurred more in the elderly and the deceased patients. Only a few DNAR orders were specified and most were initiated by the doctor.
authors.affiliation: Department of Intensive Care, Isala klinieken, Dr van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
authors.forename: Mieke
authors.initials: M
authors.lastname: Meilink
authors.forename: Koos
authors.initials: K
authors.lastname: van de Wetering
authors.forename: Helen
authors.initials: H
authors.lastname: Klip
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000375:Aging; D001291:Attitude of Health Personnel; D005260:Female; D005500:Follow-Up Studies; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data*; D008875:Middle Aged; D009042:Motivation; D009426:Netherlands; D010343:Patient Admission / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data*; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013997:Time Factors