Pre-printed 'Do not attempt resuscitation' forms improve documentation?

Objective: Do not-attempt-resuscitate orders are fundamental for allowing patients to die peacefully without inappropriate resuscitation attempts. Once the decision has been made it is imperative to record this information accurately. However, during a related research projected we noted that documentation was poor and we thought that the introduction of a pre-printed Do Not Attempt Resuscitation (DNAR) form would improve the documentation process. Design: Two sets of identical research questions were applied retrospectively, 12-months apart, to notes of adult patients ( > 18 years) who had died during a hospital admission without under-going a resuscitation attempt. Between the first and the second audit, a new resuscitation policy that incorporated a pre-printed DNAR form was introduced into our hospital. Results: A pre-printed DNAR form improved documentation when measured against; clarity of DNAR order (P = 0.05), date decision was made/implementation (P = 0.014), presence of clinician's signature (P = 0.001), identification of the senior clinician making the decision (P less than or equal to 0.001) and justification for the DNAR decision (P less than or equal to 0.001). However, the pre-printed form made little improvement in encouraging patient involvement in the DNAR decision-making process (P = 0.348). Conclusion: A pre-printed DNAR form can improve documentation significantly but it has little effect in encouraging patient involvement in the decision-making process. (C) 2003 Elsevier Ireland Ltd. All rights reserved.