[Effect of the do-not-resuscitate orders on the critical patient care plan].

BACKGROUND

Do-not-resuscitate (DNR) orders are physician orders that refer to not initiating cardiopulmonary resuscitation in a patient who is in cardiac or respiratory arrest. However, these orders often imply other treatment modifications.

AIMS: To analyze the effect that do-not-resuscitate orders have on the care plan of the critically ill patient; and to analyze if differences exist in the nursing workload (NEMS), before and after DNR prescription.

METHOD: This descriptive study analyzed the care plan of 50 critically ill adult patients, before and after an electronic DNR order.

RESULTS

After the DNR order was written the following variations were found: treatment was withdrawn in 30 patients; initiated in 6; both withdrawn and initiated in 12 patients; and there were no changes in their treatment in 2 patients. Specific modifications were: respiratory support: invasive mechanical ventilation was withdrawn in 7 patients, and non-invasive ventilation in 3, and the FiO(2) of the ventilator was reduced in 15 patients on the day of death; circulatory support: in 10 patients vasoconstrictor drugs were withdrawn and in one patient this therapy was initiated; inotropic drugs were withdrawn in 3 patients and initiated in 2 patients; extrarenal depuration hemofiltration was withdrawn in 4 patients and initiated in 2. The NEMS scores decreased on the patients after the order was written (36.20-34.62; p = 0.03).

CONCLUSIONS

Do-not-resuscitate orders have an effect on the care plan of the critically ill adult patient. Also, although the NEMS scores decrease after the order, the nursing workload remains the same due to an increase in the psychosocial intervention with patient and family.