Residents often change position on CPR, showing need for Minimum Data Set changes, researchers say

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Many nursing home residents change their mind after admission about whether they want to be revived through cardiopulmonary resuscitation, but Minimum Data Set changes threaten to decrease residents' say in end-of-life care, according to recently published research.

Researchers from the University of California-Irvine and the University of Rochester School of Medicine and Dentistry in New York analyzed a group of nursing home residents for five years after admission. Of those who entered with full-code CPR orders at admission, 40% switched to do-not-resuscitate status within five years, the researchers found.

Residents who were hospitalized or transferred to another nursing home were most likely to change their status, and black residents were more likely than white residents to change to a DNR, according to the researchers.

The high rate of change from wanting CPR to ordering a DNR suggests how important it is for caregivers to have ongoing discussions with residents about their wishes. Recent MDS changes “exclude this information from routine assessment of patients mandated by the Centers for Medicare & Medicaid Services,” the researchers pointed out. They recommend that CMS reinstate advance directive information in the MDS.

The research appears in the August 2013 issue of Med Care.