[Do-not-resuscitate orders and cardiopulmonary resuscitation at a Norwegian department of surgery].

BACKGROUND

A previous publication indicates a lack of clear guidelines for DNAR orders in Norwegian hospitals. The Norwegian Board of Health has recently published strict requirements for such a procedure.

MATERIAL AND METHODS

Patients discharged from a surgical department from 1 March to 31 May 2001 with complicated or advanced cancer and/or a postoperative stay of minimum ten days. The patient files were studied for information on DNAR orders and/or cardiac arrest.

RESULTS

13 out of 69 patients had a DNAR order. In eight of them there was either no explanatory note in the files or no correct signature. Three of the five other patients had taken part in the discussion, so had next-of-kin in two circumstances. Resuscitation was not initiated in any of 14 patients with cardiac arrest. Six of these, who had no DNAR order, all had advanced, inoperable cancer or serious chronic cardiac and respiratory failure. There were no signs that a DNAR order had influenced any other treatment decision.

INTERPRETATION

The department had a clear procedure for writing DNAR orders but it was followed in less than half of the cases.