A prospective trial of a new policy eliminating signed consent for do not resuscitate orders
A prospective trial of a new policy eliminating signed consent for do not resuscitate orders
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DOI：
10.1111/j.1525-1497.2006.00612.x
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发表时间：
2006-12-01
影响因子：
5.7
通讯作者：
Ury, Wayne A.
中科院分区：
文献类型：
--
作者：
Sulmasy, Daniel P.;Sood, Johanna R.;Ury, Wayne A.
背景：一些机构要求患者和家属签署同意不复苏（DNR）命令，特别是在纽约州。由于这可能是讨论DNR命令的障碍，我们将签署的同意政策改为有见证的口头同意政策，简化和修改DNR命令表格，并在1家医院对工作人员进行教育，将其效果与政策未改变的附属医院进行比较。设计：干预和比较地点的前瞻性自然实验。干预前后，我们调查了内务官员的信心和态度，审查了图表，以评估每个DNR命令解决的并发护理问题（CCC）的数量（例如，限制插管或血液制品或需要临终关怀），并在干预医院，使用Horowitz事件影响量表测量同意DNR命令的代理人的压力水平。我们还调查了工作人员对政策的看法后changes.RESULTS：在干预医院，内务人员报告的百分比低的信心，他们的能力，以获得同意DNR命令干预后下降（24%至7%，P= 0.002），而没有显着变化的比较医院（20%比15%，P= 0.45）。在干预医院的工作人员中，报告难以与患者和家属谈论DNR命令的百分比下降，但在比较医院没有显着变化。在干预医院，CCC/DNR订单的平均数量增加（治疗前1.0至治疗后4.2，P
BACKGROUND: Some institutions require patients and families to give signed consent for Do Not Resuscitate (DNR) orders, especially in New York State. As this may be a barrier to discussions about DNR orders, we changed a signed consent policy to a witnessed verbal consent policy, simplified and modified the DNR order forms, and educated the staff at 1 hospital, comparing the effects with an affiliated hospital where the policy was not changed.DESIGN: Prospective natural experiment with intervention and comparison sites.SUBJECTS AND MEASUREMENTS: Pre- and postintervention, we surveyed house officers' confidence and attitudes, reviewed charts to assess the number of concurrent care concerns (CCCs) addressed per DNR order (e.g., limits on intubation or blood products or need for hospice), and at the intervention hospital, measured the stress levels of surrogates consenting for DNR orders using the Horowitz Impact of Event Scale. We also surveyed staff perceptions about the policy following the change.RESULTS: At the intervention hospital, the percentage of house officers reporting low confidence in their ability to obtain consent for DNR orders declined postintervention (24% to 7%, P=.002), while there was no significant change at the comparison hospital (20% vs 15%, P=.45). Among intervention hospital house officers, there were declines in percent reporting difficulty talking to patients and families about DNR orders, but no significant changes at the comparison hospital. At the intervention hospital, the mean number of CCCs/DNR order increased (1.0 pre to 4.2 post, P