386 - Partial Codes Risk Whole Confusion: Characteristics and Outcomes of Pediatric Partial Code Orders

Publication Number: 4378.386

Rachel Jalfon, University of Tennessee Health Science Center College of Medicine, Houston, TX, United States; Brittany Cowfer, St. Jude Children's Research Hospital, Memphis, TN, United States; Sankareshwari Kalyanasundaram, St. Jude Children's Research Hospital, Collierville, TN, United States; Deena Levine, St. Jude Children's Research Hospital, Memphis, TN, United States; Griffin S. Collins, St. Jude Children's Research Hospital, Memphis, TN, United States; Erica Kaye, St. Jude Children's Research Hospital, Memphis, TN, United States; Liza-Marie Johnson, St. Jude Children's Research Hospital, Memphis, TN, United States; R. Ray Morrison, St. Jude Children's Research Hospital, Memphis, TN, United States; Ashish Pagare, St. Jude Children's Research Hospital, Memphis, TN, United States; Meaghann Weaver, St Jude Children's Research Hospital, Memphis, TN, United States

Background: Partial do-not-resuscitate (DNR) orders, directives specifying limited resuscitative efforts, are intended to align medical interventions with patient preferences. However, their complexity may introduce ambiguity, inconsistent care, and ethical challenges.

Objective: The purpose of this project was to quantify the prevalence of partial DNR orders and to characterize the preferences documented in a partial code order. The aim of this project was to inform institutional practices regarding the benefits, risks, and utility of partial code order options.

Design/Methods: A retrospective review was conducted of inpatient partial code order entries over a three-year period. Partial DNR orders were identified and categorized based on included or excluded interventions (chest compressions, defibrillation, intubation, mechanical ventilation, medications). Data was analyzed to assess the frequency, variation, and internal consistency of documented preferences as well as alignment with institutional definitions and clinical feasibility.

Results: Partial DNR orders represented a small (n=15, 7%) but notable proportion of total code status entries. Wide variability was observed in the combinations of permitted and withheld interventions, with orders containing internally conflicting instructions. Documentation of inconsistencies and unclear terminology were common, raising concerns about interpretability during emergent situations.

Conclusion(s): Partial DNR orders demonstrate heterogeneity and potential for miscommunication. These findings suggest that while partial codes may reflect nuanced patient preferences, they pose operational and ethical risks that could compromise care clarity. These findings will guide institutional deliberations regarding whether to refine, restrict, or eliminate partial code order options to enhance patient safety and decision-making transparency.

Table 1
Demographics and Partial Code Designations