CHEST Guidelines-The-Importance-of-Clarity-for-Hospital-Code-Status

The-Importance-of-Clarity-for-Hospital-Code-Status

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The document highlights the importance of clarity in hospital code status orders for resuscitation and intubation during medical emergencies, focusing on the common confusion surrounding Do-Not-Resuscitate (DNR) and Do-Not-Intubate (DNI) directives. Over the past 60 years, CPR and life support during cardiac arrests have become standard procedures. However, instances arise when these measures are not desired, prompting the use of DNAR (Do-Not-Attempt-Resuscitation) and DNI orders. Many hospitals have implemented policies with three choices: DNAR/DNI, DNAR/Intubation-Ok, and Full Code to provide clarity for emergency situations. <br /><br />A study by Dr. Rubin is referenced, which reveals considerable confusion in interpreting these orders, causing potential risks like withholding needed intubation or initiating unwanted procedures. The study suggests the importance of clear delineation into the aforementioned categories to mitigate ambiguity. Despite these efforts, challenges remain, as misinterpretations of code status and POLST (Physician Orders for Life-Sustaining Treatment) orders are common. DNAR orders may be misjudged, leading to improper denial of intensive care that a patient may actually desire.<br /><br />Solutions proposed include using code status orders as guidance strictly for emergent intubation or resuscitation, while broader care goals should be thoroughly discussed and documented separately in the patient’s records. It’s crucial that patients’ changing preferences and values are regularly confirmed, preventing unnecessary or inappropriate care based on outdated orders. Effective communication strategies and technologies like video testimonials are suggested to enhance understanding and implementation of advance care planning. The article stresses that while advance directives like CPR and intubation orders are immediately actionable, the full scope of patient preferences requires nuanced, ongoing discussion documented accurately to guide care decisions.

Keywords

hospital code status

resuscitation

intubation

DNR

DNI

DNAR

POLST

advance care planning

medical emergencies

patient preferences