'We're going to be coding dead people': Hospitals consider do-not-resuscitate order for all COVID-19 patients

Some hospitals are considering do-not-resuscitate orders for all COVID-19 patients, citing the high exposure risk for staff as protective equipment supplies run low, The Washington Post reports.

Chicago-based Northwestern Memorial Hospital is currently discussing a universal DNR policy for COVID-19 patients, regardless of patient or family wishes. Hospital administrators have asked Illinois Gov. J.B. Pritzker to clarify if state law would allow such policy changes.

Officials at Washington, D.C.-based George Washington University Hospital have modified resuscitation procedures for COVID-19 patients, such as placing a plastic sheet over the patient to create a barrier.

However, the decision is dependent upon a hospital's resources, Bruno Petinaux, MD, George Washington University Hospital's CMO, told The Washington Post, adding that he cannot rule out a change in protocol if things worsen.

Seattle-based University of Washington Medical Center has drastically reduced the number of workers responding to COVID-19 patients needing resuscitation. The decision is about "minimizing use of PPE as we go into the surge," said Tim Dellit, MD, hospital CMO.

"By the time you get all gowned up and double-gloved the patient is going to be dead," Fred Wyese, RN, an ICU nurse in Muskegon, Mich., said. "We are going to be coding dead people."

Charlotte, N.C.-based Atrium Health, Danville, Pa.-based Geisinger and regional Kaiser Permanente health networks are all examining guidelines that would let physicians override COVID-19 patient or family wishes on a case-by-case basis.

Scott Halpern, MD, PhD, a bioethicist at Philadelphia-based University of Pennsylvania, authored a model guideline many hospitals are considering. The model calls for two physicians, one who has cared for the patient and one who has not, to sign a DNR order and cite a reason for the order. The patient's family must be informed, but doesn't have to agree with the order.

"It doesn't help anybody if our physicians and nurses are felled by this virus and not able to care for us," Alta Charo, bioethicist at University of Wisconsin-Madison, told The Washington Post. "The code process is one that puts them at an enhanced risk."

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