Guidelines for the use of do-not-resuscitate orders in Dutch hospitals

Objectives: To determine the prevalence and analyze the content of guidelines for the use of do-not-resuscitate (DNR) orders in Dutch hospitals. Design: Cross-sectional descriptive study. Measurements and Main Results: A questionnaire was mailed to the directors of patient care at all 143 Dutch hospitals. Directors were asked whether their hospitals had guidelines for the use of DNR orders and to provide copies of the guidelines if they did. The content of the guidelines was analyzed with regard to basic assumptions about nonresuscitation, definitions, persons involved in decision-making, advance directives, starting discussions about nonresuscitation, notation, evaluation, and other aspects. Of the 143 hospital directors surveyed, 95% responded. Sixty percent of the hospitals had guidelines for the use of DNR orders and provided copies. The assumption "always resuscitate, unless" was mentioned in 66% of guidelines, In 93% it was stated that patients should be involved in decision-making about non-futile resuscitation. In 38% it was stated that in principle, living wills were respected in cases of incompetence. The role of proxies was mainly to discuss decisions (58% of guidelines), not to make them. The most frequently mentioned moment for starting a discussion about nonresuscitation was the onset of clinical deterioration of the patient (41%). Conclusions: It is promising that 60% of Dutch hospitals have developed guidelines for the use of DNR orders, However, current guidelines can be improved in many respects.