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Does audit improve DNR decision making?

K Stewart1, A Wagg, M Kinirons

  • 1Department of Geriatric Medicine, Newham General Hospital, London.

Journal of the Royal College of Physicians of London
|July 1, 1994
PubMed
Summary
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Hospital audits effectively improved do not resuscitate (DNR) order practices. This audit-driven approach enhanced consultant involvement and documentation, ensuring better patient care decisions and policy development.

Area of Science:

  • Medical Ethics
  • Healthcare Management
  • Clinical Practice Improvement

Background:

  • Do not resuscitate (DNR) orders are crucial in patient care but lack documented practical implementation of guidelines.
  • Hospitals face challenges in consistently applying DNR decision-making processes.

Purpose of the Study:

  • To evaluate the impact of an audit process on developing and refining hospital DNR policy.
  • To assess the practical application of DNR guidelines after implementation.

Main Methods:

  • Utilized an audit cycle to develop and review DNR policy within a hospital setting.
  • Tracked key metrics including consultant involvement, documentation of DNR reasons, and nurse discussions.
  • Analyzed changes in DNR decisions and 'for CPR' to DNR conversions.
Keywords:
Death and EuthanasiaNewham General Hospital (London)

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Main Results:

  • Early consultant involvement in DNR decisions for 69% of patients assessed.
  • Complete documentation of DNR reasons for 100% of relevant cases.
  • Consultant agreement with junior decisions in 91% of cases; 22% of 'for CPR' decisions were changed to DNR.

Conclusions:

  • Audit is an effective method for improving and developing sensitive clinical practices like DNR orders.
  • The implemented audit process successfully enhanced DNR decision-making and documentation.
  • Findings support the use of audit to refine hospital policies and clinical practice in critical care areas.