The Unintended Consequences of DNR
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Original Publish Date:
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August 24, 2011
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Review Date(s):
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NA
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Term of Approval End Date:
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August 24, 2013
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Estimated Time to Complete:
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1.5 Hours
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Risk Management:
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Yes
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Course Credit:
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CME (physicians), CE (nurses)
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| Course Format |
Text |
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Course Fee:
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Mbrs-$15, Non Mbrs-$30
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To
participate in this CME activity: (1) review the information on this
page which includes the learning objectives and faculty disclosures; (2)
read the course pages; (3) complete the exam; (4) view/print
certificate.
Course Information
General Information
If you need to stop in the middle of a course, you
may return to the course at anytime to finish. When you have finished reading the course pages
click on CME Exam in the Course Sections box (top right). To begin this CME activity, read through the
information on this page and then click on the Start Course
button.
Course Overview
Studies have shown that patients with DNR
orders receive less pain medication, less food, less water, less
frequent vital signs monitoring, fewer visits from the nurse and fewer
visits from family members. DNR orders may be open to
interpretation by the physician, physician's family and patient.
Most patients have a limited understanding of the complex medical
interventions and the implications of their decisions.
Communication barriers between the physician, medical team and patient
may exist in communicating and implementing the appropriate medical
intervention specified by the patient and/or family. The
information presented in this CME activity will provide a balanced view
of the consequences to the patient, family and the physician.
(Dr. Treisman, Professor of Psychiatry
and Behavioral Science and Professor of Medicine at Johns Hopkins
University School of Medicine and a specialist in the psychiatric
treatment of patients with HIV infection, presented this lecture at the
Ethics Forum on May 16, 2006. The content was updated and formatted for
online in summer 2011.)
Intended Audience
This course is intended for physicians, nurses and
allied health professionals.
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Course Objectives
Identify the issues involved in Do Not Resuscitate
Orders. Identify the intended and unintended implications
of DNR orders so healthcare providers may communicate these consequences
to the patients. Describe the ethical consequences of such
orders.? Define the issues related to advanced
directives.
Course Credit
Deadline for completing the course is August 24,
2013.
CME Credit
The Massachusetts Medical Society designates
this enduring material for a maximum of 1.5 AMA PRA
Category 1 Credit™. Physicians should claim
only credit commensurate with the extent of their participation in
the activity.
This program meets the criteria of the Massachusetts
Board of Registration in Medicine for risk management study.
Participants will receive a confidential report of their
examination score. You must receive a score of 70% or better to receive
AMA PRA Category 1 Credit™. A confirmation of
credit will be issued at the end of the course to those who successfully
complete the examination.
The Massachusetts Medical Society
is accredited by the Accreditation Council for Continuing Medical
Education (ACCME) to provide continuing medical education for
physicians.
CE Credit for Nurses
1.5 Contact Hours
This continuing nursing education activity was approved
by the Massachusetts Association of Registered Nurses, Inc., an
accredited approver by the American Nurses Credentialing Center's
Commission on Accreditation
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Course Fees
The Unintended Consequences of DNR and all associated
course materials are available free of charge. An opportunity to
complete an exam and receive AMA PRA Category 1 Credit™
for a nominal fee is available at the end of the course. The course fees
are as follows:
Massachusetts Medical Society (MMS) Member: $15 ($10 per
credit)
Non-MMS member: $30 ($20 per credit)
Course
Materials
The Unintended Consequences of DNR (.pdf,
527kb)
Requires Adobe Reader
Faculty
Glenn J. Treisman M.D., Ph.D. is Associate Professor
Psychiatry and Behavioral Sciences, Associate Professor of Medicine, and
Director of AIDS Psychiatry Services, Johns Hopkins University School of
Medicine.
Disclosure/Commercial Support
The following course content developers have no
financial interests or relationships to disclose.
Glenn J. Treisman M.D., Ph.D.
Diane W. Shannon, MD, MPH, Medical Writer
Kathleen Bellisle, Manager of MMS Distance Learning
Catherine Flood, BSN, RN, Lead Nurse Planner
Thelma Tatten, Program Coordinator, MMS Distance Learning
Off-label Disclosure
This course does not include any discussion of an
off-label use of a commercial product or an investigational use not yet
approved for any purpose by the FDA.
Commercial Support
No commercial support was received for this online
program.
Content Disclaimer
The Massachusetts Medical Society
does not take responsibility for the accuracy of the information in this
CME program, which was provided by Lawyers Weekly, Inc. and summarized
by Henry Tulgan, MD, FACP. The views expressed are not necessarily those
of the Massachusetts Medical Society.
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Online Course Developers
Glenn J. Treisman M.D., Ph.D.
Diane W. Shannon, MD, MPH, Medical Writer
Kathleen Bellisle, Manager of MMS Distance Learning
Catherine Flood, BSN, RN, Lead Nurse Planner
Thelma Tatten, Program Coordinator, MMS Distance Learning
Bibliography
Beach MC, Morrison RS. The effect of
do-not-resuscitate orders on physician decision-making.
J Am Geriatr Soc. 2002 Dec;50(12):2057-6
[1] Mirarchi FL, Kalantzis S, Hunter D, McCracken E,
Kisiel T. TRIAD
II: do living wills have an impact on pre-hospital lifesaving
care? J Emerg Med. 2009 Feb;36(2):105-15
[1] Katsetos AD, Mirarchi FL. A
Living Will Misinterpreted as a DNR Order: Confusion Compromises Patient
Care. J Emerg Med. 2009 Feb 12
[1] Danis M, Southerland LI, Garrett JM, Smith JL,
Hielema F, Pickard CG, Egner DM, Patrick DL. A
prospective study of advance directives for life-sustaining
care. N Engl J Med. 1991 Mar 28;324(13):882-8.
[1] Wolf SM, Boyle P, Callahan D, Fins JJ, Jennings B,
Nelson JL, Barondess JA, Brock DW, Dresser R, Emanuel L, et
al. Sources of concern about the Patient
Self-Determination Act. N Engl J Med. 1991 Dec
5;325(23):1666-71
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Contact Us
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Street, Waltham, MA 02451.
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