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

## TL;DR

This study examines partial do-not-resuscitate orders in pediatric patients and finds they can lead to confusion and inconsistent care.

## Contribution

The study identifies variability and inconsistencies in pediatric partial code orders, highlighting risks to clinical clarity and patient safety.

## Key findings

- Partial DNR orders showed wide variability in permitted and withheld interventions.
- Conflicting instructions and unclear terminology were common in partial code orders.
- The study suggests partial codes may compromise care clarity and decision-making transparency.

## Abstract

Objective—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. Design—A retrospective review was conducted of inpatient partial code order entries over a three-year period at a single institution with a pediatric oncology and immunology cohort. 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. Conclusions—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. Clinical implications are reviewed. 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.