Cardiopulmonary resuscitation in long-term care facilities: a survey of do-not-resuscitate orders in nursing homes.

Growing public debate regarding no cardiopulmonary resuscitation (no-CPR) policies in acute care hospitals, together with recent changes in the patient population of long-term care facilities, has led nursing homes to examine their need for resuscitation policies. To determine current cardiopulmonary resuscitation policies and procedures in nursing homes, medical directors and directors of nursing service in long-term care facilities in Portland, Oregon, were surveyed. Seventy-five percent responded; of these, only 41% reported having a resuscitation policy. Of those with no policy, 70% thought one was needed. Most nursing homes reported that resuscitation was infrequently discussed with patients and families. When a no-CPR determination was made, it was usually documented in the patient's chart. Training in basic life support was required for registered nurses in two thirds of the facilities. Few homes had equipment necessary for advanced life support. It is recommended that: a) nursing homes develop cardiopulmonary resuscitation policies; b) resuscitation orders be made part of the medical record; and c) nursing home personnel increase their ability to perform basic life support.