UK Quality Review: Many Patients Not Offered DNAR Option

Last week, the Local Clinical Commissioning Groups, the Leicestershire Partnership NHS Trust and the University Hospitals of Leicester NHS Trust published an innovative "quality review" examination of the health system in Leicester, Leicestershire and Rutland.



Among other findings, the reviewers found that patients did not always receive the most appropriate type of end of life care, including palliative care and the use of DNAR orders. This happened in over 10% of the examined cases.  There are two main situations.



1.  In most cases, this meant that patients who were at the end of their life and may have expressed a preference to die outside of hospital were still brought into hospital.  (This is where a POLST would have helped.)



2.  Some patients in hospital were not recognized as being at the end of life. As a result patients were resuscitated or had other forms of medical intervention when it would have been in their best interests to have had end of life care and comfort.

Frequently there was a lack of recognition for the need to broach the subject of DNAR with the patient and/or their next-of-kin resulting, at times, in inappropriate hospital admissions and treatment.