Amani Ali Babgi
Johns Hopkins Aramco Healthcare, Saudi Arabia
Title: Analysis of Do Not Resuscitate Order (DNR) & Allow Natural Death (AND) Practice in Saudi Arabia: Experience of Two Major Centers
Biography
Biography: Amani Ali Babgi
Abstract
Sami Al Shammari, King Fahad Medical City, Saudi Arabia; Mona Shehabi, King Fahad Specialist Hospital, Saudi Arabia; Mohammed AboSeda, King Fahad Medical City, Saudi Arabia; Helen McGrath, Johns Hopkins Aramco Healthcare, Saudi Arabia; Zainab Abdrabalnabi, King Fahad Specialist Hospital, Saudi Arabia
Background
Do Not Resuscitate (DNR) and Allow Natural Death (AND) orders are becoming more common in practice in Saudi Arabia when dealing with terminally ill and dying patients1-8. The international literature reports that patients and families are increasingly part of the decision making process when it comes to Cardio Pulmonary Resuscitation CPR in emergency situations and critical illnesses, and patients can assign a proxy to take a decision on their behalf if they are not in a position to do so9-17. How is this applied in Saudi Arabia as a practice? The purpose of this study was to determine and examine the utilization of DNR orders in 3 major hospitals in Saudi Arabia.
Methodology
Medical records of patients with a documented DNR order between 2011 and 2016 were retrospectively reviewed after receiving IRB approval from each hospital. The sample included medical records of more than 300 patients from the 3 major hospitals. A data collection sheet comprising patients’ demographics and DNR information was used. Data were collected, assigned serial code numbers and analyzed according to data analysis plan.
Results
The following is the preliminary results from one hospital the other two hospitals’ data are under processing. The average age of patients was 61 years. DNR was signed in an inpatient area for 86% of patients, while 67% died in a hospital ward.
The average number of admissions before DNR signature was 4 admissions with SD of 6 compared to 1 admission with SD of 2 after signature. The average length of stay (LOS) from diagnosis to palliative care referral was 600 days with SD 716 days. The average LOS from DNR signature to palliative care referral was 87 days with SD of 171 days. The average LOS in days from palliative care referral to death was 68 with SD of 102 days.
Conclusion
Based on the preliminary results, there is a notable fact that patients are not informed about their DNR status, but more family members are. Documentation of DNR status and plan of care remains an issue. There is a delay in referring patients to palliative care services.