Stewart K, Wagg A, Kinirons M
Department of Geriatric Medicine, Newham General Hospital, London.
J R Coll Physicians Lond. 1994 Jul-Aug;28(4):318-21.
The use of 'do not resuscitate' (DNR) orders in hospitals has been the subject of considerable comment in both the medical and the lay press. Guidelines have been produced to help make DNR decisions but, as yet, there have been no published accounts of these in practice. We have used audit to accounts of these in practice. We have used audit to develop DNR policy in our hospital, and have reviewed practice after the introduction of guidelines. This led to early consultant involvement in making decisions in 55 of 80 patients (69%) who were assessed as DNR at the time of death or discharge, documentation of reasons for DNR in all 55 of these and documentation of discussion with nurses in 49 (89%). Consultants agreed with DNR decisions made by their juniors in 31 of 34 cases (91%) and changed 'for CPR' decisions to DNR in 24 of 108 (22%). We have demonstrated that audit is an appropriate way to change and develop practice in sensitive areas such as this.
医院中“不要复苏”（DNR）医嘱的使用一直是医学和大众媒体大量评论的主题。已经制定了指导方针来帮助做出DNR决策，但到目前为止，尚无关于这些指导方针实际应用情况的公开报道。我们通过审计来了解这些在实际中的情况。我们利用审计在我院制定了DNR政策，并在引入指导方针后对实际情况进行了审查。这使得早期顾问参与了80例患者中55例（69%）的决策，这些患者在死亡或出院时被评估为DNR，所有这55例患者都记录了DNR的原因，其中49例（89%）记录了与护士的讨论情况。在34例病例中的31例（91%），顾问同意其下级做出的DNR决策，并且在108例中的24例（22%）将“进行心肺复苏”的决策改为DNR。我们已经证明，审计是在如此敏感的领域改变和发展实际做法的一种恰当方式。
