(C) Choice—reduce complexity | | Replace ‘Do Not Resuscitate (DNR)’ with ‘Do Not Attempt Resuscitation (DNAR)’. Simplify code status choices to three options: DNAR, DNAR/OK to Intubate; and Full Code.
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(O) Order—entry support | Standardised code status order entry. Widely understood periprocedural resuscitation policies. Code status reconciliation across clinical encounters.
| Develop and implement procedural resuscitation orders that demand timed Full Code order expiration for procedural DNR reversals. Include guideline-based code status recommendations to preprocedural checklists. Implement EHR interruptive alerts to reconcile code status order discrepancies AND guide clinicians to perform serious illness conversation for high-risk patients.
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(D) Discuss—don’t delay | | Add code status to EHR dashboards and implement decision support tools to guide clinicians to perform and document serious illness conversations in high-risk patients. Eliminate ‘Presumed’ code status as a durable order on hospital admission.
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(E) Educate—the workforce | | | |
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