Do-not-resuscitate practice, guidelines and policies in long-term care in Ontario: results of a survey.

We used a survey to determine the prevalence of do-not-resuscitate (DNR) guidelines and protocols, and opinions related to cardiopulmonary resuscitation (CPR) in facilities that provide long-term care (LTC) in Ontario. Questionnaires completed by 357 of 474 facilities providing LTC, revealed that most have written DNR policies. Over half inform residents about the policy on admission, and a third later on, with most indicating DNR status on the chart. Over half the institutions can provide CPR, mostly basic cardiac life support. Most institutions rely on emergency ambulance services to treat cardiac arrests. In the absence of a DNR order, almost half will perform CPR, and a quarter have a protocol to deal with this circumstance. Most respondents indicated that staff, families and residents would welcome a protocol to deal with absent DNR orders in cardiac arrests. Most believe that staff, families and residents would welcome DNR as the basic policy, with CPR as the exception. There is a high awareness in facilities that provide LTC of the limits of CPR in the elderly. Without specific legislation, most facilities have policies and protocols, but there are inconsistencies across Ontario.