Publication Date
4-28-2026
Degree Awarded Date
December 18, 2026
Abstract
Background & Significance: Management of do-not-resuscitate (DNR) orders during the perioperative period presents ongoing ethical and clinical challenges. Variability in provider knowledge and documentation can compromise patient autonomy and safety. Despite institutional policies, such as Barnes-Jewish Hospital’s “Goals of Care Directive,” inconsistent adherence remains common.
Review of Literature Findings: Evidence reveals that limited provider education contributes to uncertainty in managing perioperative DNRs. Studies by Baumann et al. (2017), Chappell et al. (2023), and Crowe and Marsh (2023) support targeted educational interventions to improve provider competence and consistency with national guidelines regarding required reconsideration.
Methods: Preintervention and postintervention surveys will be used to assess changes in Washington University School of Medicine (WUSM) Department of Anesthesiology and Surgery providers' knowledge and comfort regarding DNR orders. The DNP QI project will be conducted at Barnes-Jewish Hospital (BJH). The data collected will be analyzed to determine the effectiveness of the educational intervention on provider knowledge and comfort.
Results/Discussion of Findings: The quality improvement initiative successfully improved engagement, comfort, and knowledge among anesthesia and surgical providers regarding perioperative DNR management. Over 70% of participants accessed the educational intervention, with a significant increase in reported prior education on DNR policies (χ² = 6.706, p = 0.035). Provider comfort “comfortable” or “very comfortable” with DNR decision-making increased 13% (44% to 57%), particularly in discussions with patients and families. Knowledge of federal, professional, and institutional DNR policies improved across all domains, including 52% for the PSDA, 43% for ASA Ethical Guidelines, 55% for AANA Reconsideration of Advance Directives, and 47% for the institutional Goals of Care Directive, with a composite 73% gain overall. These results demonstrate that a brief, targeted educational intervention can effectively enhance provider engagement, knowledge, and comfort, supporting consistent, ethically grounded perioperative care for patients with DNR orders.
Implications: Targeted education effectively enhanced provider understanding and comfort with perioperative DNR management. Integration of ongoing education and electronic prompts within the EHR could sustain these gains and promote consistent, patient-centered care.
Summary: This quality improvement project demonstrated that structured education increases provider comfort, knowledge, policy adherence, and respect for patient autonomy in perioperative DNR management.
Language
English (en)
Document Type
Other
Advisor
Perez, Sarah DNP, CRNA (Chair) Barnes-Jewish College, Goldfarb School of Nursing
Associated Committee
Henrichs, Bernadette PhD, CRNA, CCRN, CHSE, FAANA, FAAN (Committee Member) Barnes-Jewish College, Goldfarb School of Nursing
Recommended Citation
Popejoy, Brooke; Lebsack, Connor; and Bish, Rena, "Do-Not-Resuscitate Orders in the Perioperative Period: A Quality Improvement Project" (2026). Doctor of Nursing Practice (DNP) Student Projects. Paper 26.
Retrieved from https://digitalcommons.wustl.edu/dnp_golfarb/26
