The Do-Not-Resuscitate (DNR) status was created in 1960. The complexity of clinical practices and procedures have dramatically shifted as well resulting in longer life expectancy. The current era of evidence-based practice and translation research has ushered in new opportunities and responsibilities for the health care team. The location of where care is delivered has also become more diverse. Yet, the legacy of DNR practices has failed to evolve as much as the evolution in healthcare itself. DNR status is part of the advanced directive (AD) and should be followed as the patien’s expressed wishes. The AD details what values patients have in regard to quality of life and is most useful in non-emergent situations. The AD informs the healthcare team about important issues such as endotracheal intubation and cardiopulmonary resuscitation (CPR) – all emergent conditions where the outcomes may affect the quality of life. Ambulatory surgery patients are generally presumed to be stable and carry a low risk of unexpected outcomes. However, emergent situations can arise and these situations present an ethical and clinical dilemma to providers when the patient has an active DNR. The American Academy of Nurse Anesthetists provides guidelines regarding the management of patients in the ambulatory surgical setting who have expressed their intentions through an executed AD and DNR. Rarely is the topic of what to do in the event of an emergency discussed with patients who have DNR status. Equally rare is the patients’ understanding that he AD and DNR can be temporally suspended or completely rescinded by the patient. This evidence-based quality improvement change project is tailored to the topic of educating staff members on the need for a policy change concerning DNR suspension in the ambulatory surgical center. Ian Graham’s Knowledge to Action Model was chosen as this evidence-based practice framework guide, and Richard Ryan and Edward Deci’s Self-Determination Theory was chosenas the theory to guide this project. Four objectives influenced this improvement project: 1) educating staff members on the current anesthesia policy, 2) educating staff members on what suspension of DNR status entails, 3) measuring the impact of knowledge gained regarding a change in DNR status among staff members, and 4) presentation of a new anesthesia policy to incorporate all levels of DNR suspension. Current DNR practices are outdated and must change. Change is difficult in most professions. However, change in healthcare is imperative, if forward movement is the goal. Maintaining a patients’ autonomy, while providing competent and comprehensive healthcare needs to be part of the forward goal that we seek to achieve.
