Does the presence or type of hospital DNR policy influence DNR orders or discussions about limiting care in any way?
Data support a grade III recommendation for a DNR policy in all hospitals. The presence and composition of DNR policies varies from hospital to hospital, although guidelines from the American Hospital Association suggest policies should be humanistic, practical, and disseminated to those who will be using them. Compliance with a DNR policy increases in the years after its implementation. The presence of a DNR policy may increase the number of patients with DNR orders and increase the amount of consultation done by the responsible physician (level III and IV). More data support that the documentation behind DNR orders and clarity of specific interventions increases when a policy is implemented without increasing the overall number of patients with DNR orders (levels II-V). The patient self-determination act appears to have had no influence on the number of hospitalized patents with DNR orders, perhaps because only 41–65% of patients receive information about advance directives (level II
