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Improving the documentation and appropriateness of cardiopulmonary resuscitation decisions
C L Hignett1, D R Forsyth, G D Connor
1Department of Medicine for the Elderly, Addenbrooke's NHS Trust, Cambridge, UK.
Insights
An audit of cardiopulmonary resuscitation (CPR) decisions in elderly medicine found that while appropriateness was generally agreed upon, nearly half of resuscitation decisions in the final year were deemed inappropriate, highlighting a need for improved documentation and decision-making.
Area of Science:
- Geriatric Medicine
- Medical Auditing
- Clinical Decision-Making
Background:
- Cardiopulmonary resuscitation (CPR) is a critical intervention in acute care settings.
- Ensuring the appropriateness of CPR decisions and accurate documentation of resuscitation status is vital, particularly in vulnerable elderly populations.
- Previous audits have highlighted variability in CPR practices and documentation.
Purpose of the Study:
- To conduct a criterion-based audit over three years to assess the appropriateness of CPR decisions.
- To evaluate the recording of resuscitation status in medical and nursing notes for patients undergoing CPR.
- To identify areas for improvement in CPR practices within a department of medicine for the elderly.
Main Methods:
- A 3-year criterion-based audit was performed in a 112-bed department of medicine for the elderly.
- Data collected included CPR decisions and the recording of resuscitation status.
- Auditors assessed the appropriateness of CPR decisions based on predefined criteria.
Main Results:
- Resuscitation status was initially unrecorded in 100% of cases during the first two audit years.
- Documentation of resuscitation status improved to 71% in the final audit year.
- Auditors agreed on the appropriateness of CPR in 91% of cases.
- In the third year, 40% of CPR decisions were judged inappropriate.
Conclusions:
- While agreement on CPR appropriateness was high, a significant proportion of decisions were deemed inappropriate in the final audit year.
- There was a marked improvement in the documentation of resuscitation status over the audit period.
- Findings suggest a need for enhanced clinical judgment and systematic documentation regarding CPR in elderly care.
Abstract:
A criterion based audit was undertaken, over a 3 year period, to review the appropriateness of the decision to undertake cardiopulmonary resuscitation (CPR) and the recording of resuscitation status in a 112 bedded department of medicine for the elderly. Resuscitation status was not recorded in either nursing or medical notes of patients undergoing CPR during the first two 12 month audit periods, and was recorded in 71% in the final 12 month audit period. The auditors agreed in 91% of cases that CPR was either appropriate or inappropriate. In the third year of audit 40% of decisions to resuscitate were judged inappropriate.