Dr. Wachter is a member of the Scientific Advisory Boards of Google Health, Intellidot, Codigy, and Hoana Medical and a member of the Board of Directors of the American Board of Internal Medicine.
Identification of inpatient DNR status: A safety hazard begging for standardization
Article first published online: 13 DEC 2007
Copyright © 2007 Society of Hospital Medicine
Journal of Hospital Medicine
Volume 2, Issue 6, pages 366–371, November/December 2007
How to Cite
Sehgal, N. L. and Wachter, R. M. (2007), Identification of inpatient DNR status: A safety hazard begging for standardization. J. Hosp. Med., 2: 366–371. doi: 10.1002/jhm.283
- Issue published online: 13 DEC 2007
- Article first published online: 13 DEC 2007
- Manuscript Accepted: 20 AUG 2007
- Manuscript Revised: 12 JUL 2007
- Manuscript Received: 14 MAY 2007
- patient safety;
- Do Not Resuscitate orders;
- patient wristbands
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. Journal of Hospital Medicine 2007;2:366–371. © 2007 Society of Hospital Medicine.