Do-Not-Hospitalize Orders in Nursing Homes: "Call the Family Instead of Calling the Ambulance".

Abstract:

OBJECTIVES:To determine how do-not-hospitalize (DNH) orders are interpreted and used in nursing homes (NHs) once they are in place. DESIGN:Qualitative study using in-depth semi-structured interviews performed from December 2013 to April 2014. SETTING:Eight skilled nursing facilities in Connecticut that ranked in the top 10% or bottom 10% in hospitalization rates from 2008 to 2010. PARTICIPANTS:Nursing facility staff members (N = 31). MEASUREMENTS:A multidisciplinary team performed qualitative content analysis. The constant comparative method was used to develop a coding structure and identify themes. RESULTS:DNH orders were uncommon at low- and high-hospitalizing facilities. Participants reported that they did not interpret these orders literally. A DNH order was not a prohibition against hospitalization but was understood to have a variety of exceptions. These orders functioned primarily as a signal that hospitalization should be questioned and discussed with the family when an acute event occurred. CONCLUSION:In-the-moment discussions about hospitalization are still necessary even when a DNH order is in place. Work to reduce potentially burdensome NH-hospital transfers needs to focus not just on eliciting preferences in advance, but also on preparing residents and their families to make the best decisions about hospitalization when the time comes.

journal_name

J Am Geriatr Soc

authors

Cohen AB,Knobf MT,Fried TR

doi

10.1111/jgs.14879

subject

Has Abstract

pub_date

2017-07-01 00:00:00

pages

1573-1577

issue

7

eissn

0002-8614

issn

1532-5415

journal_volume

65

pub_type

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