Sehgal Niraj L, Wachter Robert M
Division of Hospital Medicine, University of California, San Francisco, California 94143, USA.
J Hosp Med. 2007 Nov;2(6):366-71. doi: 10.1002/jhm.283.
Ascertaining and documenting patients' preferences regarding end-of-life care is required by accrediting organizations at hospital admission. However, hospitals vary widely in their methods of making these preferences (including do-not-resuscitate [DNR] status) available to frontline providers, increasing the potential for errors.
We surveyed 127 nursing executive members of the University HealthSystem Consortium (an alliance of academic medical centers), asking them to describe the current practices of their hospitals in identifying DNR orders. For those at institutions using color-coded wristbands, we also asked about other patient data depicted by wristbands and the choice of colors for DNR and these other indications. We used a commercial online survey tool with E-mail distribution.
Sixty-nine nurse executives completed the survey (54%). Fifty-six percent of hospitals use paper documentation as their only mode to identify DNR orders, 16% use electronic health records, and 25% augment either paper or electronic documentation with a color-coded patient wristband. Of those using color-coded wristbands (n = 17), 8 color schemes were reported. More than 70% of respondents recalled situations when confusion around a DNR order led to problems in patient care.
Mechanisms to identify DNR orders vary significantly. For hospitals that use color-coded wristbands, the variety of color choices poses a risk for confusion and error. Building on existing and isolated state initiatives, a national mandate to standardize DNR identification and the color of patient wristbands would reduce the potential for errors and promote adherence to patients' wishes.
认证机构要求医院在患者入院时确定并记录其关于临终关怀的偏好。然而，医院在向一线医护人员传达这些偏好（包括不要复苏[DNR]状态）的方式上差异很大，从而增加了出错的可能性。
我们对大学卫生系统联盟（一个学术医疗中心联盟）的127名护理行政人员进行了调查，要求他们描述其医院目前在识别DNR医嘱方面的做法。对于那些使用颜色编码腕带的机构，我们还询问了腕带上显示的其他患者数据以及DNR和其他指征的颜色选择。我们使用了一个通过电子邮件分发的商业在线调查工具。
69名护理行政人员完成了调查（54%）。56%的医院仅使用纸质文件作为识别DNR医嘱的唯一方式，16%使用电子健康记录，25%通过颜色编码的患者腕带增强纸质或电子文件。在使用颜色编码腕带的医院（n = 17）中，报告了8种颜色方案。超过70%的受访者回忆起DNR医嘱引起混淆从而导致患者护理出现问题的情况。
识别DNR医嘱的机制差异很大。对于使用颜色编码腕带的医院，颜色选择的多样性带来了混淆和出错的风险。在现有的和孤立的州级举措的基础上，一项使DNR识别和患者腕带颜色标准化的国家指令将减少出错的可能性，并促进对患者意愿的遵守。
