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Pennsylvania Patient Safety Authority Releases December Advisory
Date:1/12/2009

f-life healthcare decisions when he or she cannot express them personally to a physician or other healthcare provider. A living will is considered a type of advance directive. An advance directive refers to a number of different documents executed by an individual intended to convey that individual's preferences about healthcare. However, a DNR is a medical order issued by a physician or other healthcare practitioner authorized to issue medical orders that directs clinicians not to provide cardiopulmonary resuscitation (CPR) in case of a heart attack or the patient stops breathing.

According to Authority data: 37 of the reports related to advance directives have involved a patient receiving potentially unwanted interventions.

"From the data we analyzed there appears to be patients who received unwanted care and were brought back to life and others who did not receive the appropriate care to save their lives," Clarke said. "The issue is very complicated and protocols vary from facility to facility in regard to DNR orders, while what constitutes a living will becoming effective is determined by Pennsylvania statute."

Clarke added that patients and their families must know that due to the varying degrees of DNR orders in facilities, a DNR order in one facility does not automatically carry over to another facility if that patient is transferred. Also, DNR orders are only effective per hospital visit. DNR orders do not remain effective after the patient leaves the hospital.

According to the Authority data: 71 of the reports show some form of communication breakdown related to advance directives. Of the issues reported, the majority of reports involve the lack of understanding of the meaning of the documents by families, lack of communication of the presence of a DNR order between healthcare providers, misidentification of patients and the failure to identify patients with DNR orders.

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SOURCE Pennsylvania Patient Safety Authority
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