Do-Not-Resuscitate Orders in the Perioperative Environment: A Multidisciplinary Quality Improvement Project

Do-not-resuscitate (DNR) orders in the perioperative environment must be managed according to national and institutional guidelines. Health care professionals, including perioperative nurses, may be unfamiliar with the guidelines and unsure of their role in reevaluating a DNR order. We conducted a multidisciplinary quality improvement project at a metropolitan community hospital that aimed to improve health care providers' compliance with the institutional policy, nursing involvement in DNR reevaluation, and communication between providers. The project intervention was an educational fair preceded and followed by a survey measuring knowledge about DNR orders, institutional policy, and national guidelines; attitude toward and comfort with the reevaluation process; and the effectiveness of the communication processes. Knowledge of DNR orders improved (P < .0001) for three of four survey questions. Attitude, comfort, and communication also improved (P < .01). A chart audit two months after the intervention showed that compliance with the institutional policy increased by 75%.