Follow us on Twitter

MNAAP Newsletter

Beyond Automatic Repeal: The New AAP Recommendations of Do Not Attempt Resuscitation Orders for Children

By Naomi Goloff, MD, FAAP, University of Minnesota Masonic Children’s Hospital and Fairview Home Care and Hospice

naomiThe American Academy of Pediatrics (AAP) recently released new guidelines about intraoperative resuscitation for a patient with a serious illness and a pre-existing Do Not Attempt Resuscitation (DNAR) order.

Until recently, it had been standard practice to routinely “rescind” the DNAR in the perioperative period. Instead, the new AAP report describes a “required reconsideration” of the DNAR, a process of re-evaluation of DNAR orders that are incorporated into the process of informed consent prior to surgery and anesthesia.

It recommends an integrated approach involving attending anesthesiologists, surgeons, primary physicians or subspecialists and/or the palliative care team in these conversations. Essential components are clear documentation of the conversation and decisions, as well as clear communication with the entire team, especially the anesthesiologist and surgeon performing the case (many times the clinician getting consent, often with regards to anesthesia, will not be the one involved in the actual case). These recommendations also allow for a physician to withdraw from the case if he or she is unwilling or unable to implement the decision of the patient and/or family.

The report outlines 3 options or approaches for “required reconsideration.”

Read more...Read More