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Characteristics and outcome of patients with DNACPR orders in an acute hospital; an observational study
Zoë B McC Fritz1, Richard M Heywood2, Suzanne C Moffat3
1Department of Acute Medicine, Box 148, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
Aims:
To establish the characteristics and outcomes of patients with Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders; to assess whether particular patient characteristics are associated with discussing resuscitation orders with patients.
Methods:
Retrospective case note analysis from an acute hospital in 2009 was performed on: all in-hospital deaths; all patients who had carbon-copies of their DNACPR forms returned to the resuscitation department and a sample of age-matched discharged patients without known DNACPR order forms. Univariate and multivariate logistic regression analysis was used to test the significance of the associations and calculate odds ratios.
Results:
Of 541 sampled patients, 51% of patients with DNACPR orders were discharged. Baseline characteristics of those who had in-hospital deaths or were discharged with DNACPR orders were similar. The overall one-year mortality for patients with a DNACPR order was 83%. 50% of patients had documentation of having DNACPR orders discussed: this was consistent across patient characteristics including those who were discharged and those who had in-hospital deaths. Cases of "inappropriate" resuscitation attempts were identified.
Conclusions:
About half of patients with DNACPR orders were discharged home, and 17% were alive at one year. Characteristics of patients and frequency of discussions were similar in those who died or were discharged. Current focus of use of DNACPR orders only on those identified as most likely to die makes inappropriate resuscitation attempt a likely occurrence, and care is required to ensure conflation with "end of life" pathways does not distort the treatments given to this vulnerable group.
