Mittelberger J A, Lo B, Martin D, Uhlmann R F
University of California, San Francisco School of Medicine.
Arch Intern Med. 1993 Jan 25;153(2):228-32.
Serious problems exist with respect to documentation of do not resuscitate (DNR) orders. We studied the impact of a procedure-specific DNR order form on documentation of these orders.
We prospectively compared DNR chart documentation during a 3-month period before and after implementation of a procedure-specific DNR order form.
The order form was used in 41 (93%) of 43 charts after its implementation. Documentation of attending physician agreement with the DNR order form increased from 30 of 34 charts in which the order form was used). The number of orders where it was uncertain whether at least one component of acute cardiopulmonary life support-related procedures was to be performed decreased from 30 (88%) of 34 charts to three (7%) of 43 charts. The order form had no measurable impact on documentation of DNR discussion. Only 25% of the charts had any discussion of the risks and benefits of CPR.
A procedure-specific DNR order form can improve documentation of DNR decisions. The reduction of uncertainty in these orders about the use of specific procedures can prevent errors in patient care.
在不进行心肺复苏（DNR）医嘱的记录方面存在严重问题。我们研究了一种针对特定程序的DNR医嘱表格对这些医嘱记录的影响。
我们前瞻性地比较了实施针对特定程序的DNR医嘱表格前后3个月期间的DNR图表记录情况。
该医嘱表格实施后，43份图表中有41份（93%）使用了该表格。使用该医嘱表格的34份图表中，记录主治医师同意该DNR医嘱表格的情况从30份增加到了（使用该表格的图表中的情况）。对于是否要进行至少一项与急性心肺生命支持相关程序的组成部分存在不确定的医嘱数量，从34份图表中的30份（88%）减少到了43份图表中的3份（7%）。该医嘱表格对DNR讨论的记录没有可测量的影响。只有25%的图表对心肺复苏的风险和益处进行了任何讨论。
一种针对特定程序的DNR医嘱表格可以改善DNR决策的记录。减少这些医嘱中关于特定程序使用的不确定性可以防止患者护理中的错误。
