The staff are eager to focus on how decisions are being made with patients and families, and whether or not the existence and meaning of the do not attempt resuscitation (DNAR) orders are discussed in establishing Goals of care.
The concern is that goals of care discussions are not being had, or that they’re being established when patients are being transferred from continuing care because they’re in some degree of respiratory crisis. There is also concern that due to time pressures providers participating in goals of care discussions are not exploring DNAR orders in depth.
Some team members say that it’s difficult to raise DNAR orders in goals of care conversations because some patients and many family members feel that the presence of the DNAR order means that they won’t get the same treatment as a patient without an order and so are then more prone to request that “everything” be done.
One strategy that you identify in the course of the discussion is providing Education for patients and families about the role of DNAR orders in health care and the commitment that providers have to ensuring that care needs are met for all patients, regardless of DNAR status.