Cardiopulmonary resuscitation: capacity, discussion and documentation

Area of Science:

• Geriatric Medicine
• Palliative Care
• Medical Ethics

Background:

• End-of-life care decisions, including cardiopulmonary resuscitation (CPR), require patient capacity for effective decision-making.
• Assessing decision-making processes for CPR is crucial in elderly populations.

Purpose of the Study:

• To evaluate the prevalence and documentation of CPR decisions in patients over 65 years old within an acute hospital setting.
• To examine the extent of patient and family involvement in CPR decisions.
• To determine the frequency of capacity assessments in CPR decision-making.

Main Methods:

• Prospective audit of patient records and resuscitation forms on Elderly Care and General Medicine wards.
• Review included CPR decisions, patient/family involvement, and capacity assessments.

Main Results:

• Elderly Care wards documented 37 CPR decisions for 104 patients; General Medicine wards documented only one decision for 40 patients.
• Patient views were incorporated in approximately 25% of geriatrician decisions; family notification was documented in only one-third of 'not for CPR' cases.
• Capacity assessment was explicitly documented in only four instances.

Conclusions:

• Geriatricians initiate CPR decisions more often than general physicians, yet patient/family engagement is limited.
• Explicit documentation of capacity assessment for CPR decisions is rare.
• A structured approach and patient information leaflets could enhance the quality and volume of CPR decision-making.