Certified Registered Nurse Anesthetists' Management of the Perioperative Do-Not-Resuscitate Order: Evaluating Trends in Required Reconsideration.

Required reconsideration or review of do-not-resuscitate (DNR) orders perioperatively is recommended by the American Association of Nurse Anesthesiology and other organizations instead of automatic suspension of the DNR. A survey on perioperative DNR orders developed for a 2000 study by Coopmans and Gries was amended, reviewed by an expert panel, reformatted for web-based layout, and emailed to a random sample of 3,000 practicing Certified Registered Nurse Anesthetists (CRNAs) in the United States. From 207 returned responses, most CRNAs (63.5%) initially reported unfamiliarity with required reconsideration. After receiving a definition of the term, more CRNAs reported familiarity and past education on the concept. Chi-square analyses showed that familiarity with required reconsideration was associated with potential refusal to care for patients with active DNR orders (P=.004). CRNAs reported education or training on required reconsideration as uncommon and often informal. The survey found significant changes in reported perioperative DNR orders at practice institutions between the original survey by Coopmans and Gries and the present study. CRNAs' responses from the present survey indicate significant increases in policies of required review with patient involvement and policies of informed routine suspension (P<.001). Findings also revealed a significant decrease in reported policies of uninformed routine suspension (P<.001).