"Not-for-resuscitation" orders in Australian public hospitals: policies, standardised order forms and patient information leaflets.

Objective: To determine the prevalence and content of policies, standardised order forms (SOFs) and patient information leaflets (PILs) pertaining to "not-for-resuscitation" (NFR) orders in Australian public hospitals.

Design And Setting: Cross-sectional postal survey conducted across Australia from August to December 2005, using a one-page questionnaire.

Participants: Directors of Medical, Nursing or Clinical Services of all public hospitals in Australia with 60 or more beds, excluding psychiatric, military and private hospitals.

Main Outcome Measures: Prevalence of documented NFR policies, by hospital characteristics, and content of these policies, SOFs and PILs.

Results: 222 hospitals were surveyed, and 157 responded (71%). Of these, 85 (54%) had NFR policies, 62 (39%) had SOFs, and four (3%) had PILs. Hospitals with more than 200 beds were more likely to have NFR policies than those with 60-200 beds (P = 0.04). More metropolitan than rural hospitals had NFR policies (P = 0.01). More hospitals with 60-100 beds had SOFs than hospitals with 101-200 beds (P = 0.03). "NFR" was defined in 53% of policies, while 97% of policies explicitly stated where NFR orders were to be documented, 89% stated who was allowed to make them, 37% stated that advanced care directives ("living wills") were to be respected, and 89% stated that competent patients should be involved in discussions regarding their NFR status. The most common items noted in SOFs were the name and signature of the issuing medical practitioner (92%) and documentation of the discussion with the patient (81%).

Conclusions: There was wide variation in the content of hospital policies, SOFs and PILs pertaining to NFR orders. Aspects of current policies show room for improvement.