'Do not attempt resuscitation'--do standardised order forms make a clinical difference above hand-written note...

Area of Science:

• Medical Ethics
• Emergency Medicine
• Clinical Practice Improvement

Background:

• Do Not Attempt Resuscitation (DNAR) orders are crucial for patient autonomy and resource allocation.
• Current methods for documenting DNAR orders, such as handwritten notes, may lack standardization.
• Standardised Order Forms (SOFs) were introduced to improve the clarity and consistency of DNAR documentation.

Purpose of the Study:

• To evaluate the impact of implementing Standardised Order Forms (SOFs) for DNAR orders.
• To assess changes in the selection and survival of patients undergoing cardiopulmonary resuscitation (CPR) attempts.
• To quantify the effect of SOFs compared to traditional handwritten notes on CPR outcomes.

Main Methods:

• A prospective, observational study was conducted in two UK hospitals.
• Data were collected for CPR attempts over two years before and two years after the introduction of SOFs.
• Key metrics included the number, demographics, and survival rates of CPR attempts, with SOFs being the sole policy change.

Main Results:

• The introduction of SOFs did not significantly alter the overall number of CPR attempts (0.30% pre-SOFs vs. 0.32% post-SOFs).
• The median duration of CPR attempts significantly increased by 3-4 minutes after SOF implementation (p=0.02).
• No significant changes were observed in patient age, timing of arrests, initial shockable rhythm, or survival to discharge.

Conclusions:

• Standardised Order Forms (SOFs) for DNAR orders are associated with a longer duration of CPR.
• The implementation of SOFs did not impact the overall number, patient demographics, or survival rates of CPR attempts.
• SOFs may influence CPR management duration without altering patient selection or survival outcomes.