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Improving decision-making and documentation relating to do not attempt resuscitation orders
J V Butler1, P K Pooviah, D Cunningham
1Department of Adult Medicine, Caerphilly District Miners Hospital (CDMH), Gwent Healthcare NHS Trust and University of Wales College of Medicine, Cardiff, UK. john.butler22@hotmail.com
Introduction:
Do not attempt resuscitation (DNAR) decision-making and recording in case notes can be poor. We have audited current practices pertaining to DNAR orders in a district hospital before and after the introduction of a standardised order form (SOF).
Methodology:
DNAR decisions in medical case notes were audited before and after the introduction of a SOF. All aspects of the decision were scrutinised against recommended guidelines (BMA/RCN/RC (UK) London: BMA, 1999).
Results:
Case notes of 156 patients were examined. A total of 62 (39.7%) had combined case note and SOF documentation (Gp1), while 94 (60.3%) had case note documentation only (Gp2). Some 61/62 (98.4%) of DNAR indications in Gp1 were in accordance with guidelines versus 81/94 (86.2%) in GP2 (P<0.01) and 50/62 (80.6%) of decisions were reviewed in GP1 versus 36/94 (38.3%) in GP2 (P<0.001). More decisions were authorised by consultants in GP1 (56/62 (90.3%) vs. 35/94 (37.2%) P<0.001) and had active patient participation (9/62 (14.5%) vs. 1/94 (1.1%) P<0.001) compared with Gp2.
Conclusion:
Documentation of DNAR decisions in medical case notes is poor. Standardised order forms, based on recommended national guidelines that complement case note entries, improve the process and recording of this sensitive decision.
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