Do not attempt cardiopulmonary resuscitation documentation: a quality improvement project

Area of Science:

• Healthcare Quality Improvement
• Clinical Documentation Standards
• Patient Communication in Healthcare

Background:

• Effective documentation of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions is crucial for patient care and legal compliance.
• Previous documentation practices in the Welsh NHS trust required enhancement to ensure clarity and consistency.

Purpose of the Study:

• To implement and evaluate quality improvements in DNACPR documentation within a Welsh National Health Service (NHS) trust.
• To enhance the clarity and completeness of DNACPR forms and discussions.

Main Methods:

• A quality improvement project involving a clinical review cycle of 100 DNACPR forms (50 per data collection).
• Utilized the all Wales DNACPR audit template for standardized criteria.
• Introduced a new national DNACPR form and conducted educational events on the all Wales DNACPR policy.
• Disseminated electronic learning resources, including TalkCPR videos and electronic staff record modules.

Main Results:

• The evaluation demonstrated improved consistency in DNACPR form completion after implementing changes.
• The new national form facilitated clearer documentation of patient and significant other discussions.
• Reasons for not holding conversations and the timing of discussions were better documented.

Conclusions:

• The quality improvement initiatives demonstrably enhanced DNACPR discussion documentation in several key areas.
• A centralized electronic record for advance care plans could further improve upon the current paper-based system, enhancing accessibility for all stakeholders.