Abstract
Introduction: Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision and plan for escalation of care are essential components of holistic care for frail and elderly patients. Inappropriate resuscitation attempts in those populations lead to distress and harm. Improving communication about end-of-life care plan between healthcare professionals and patients/ families is key to delivering dignified care and reducing emergency “inappropriate crash calls”.
Aim: The aim of this project was to assess and improve the completion rate of DNACPR forms and care escalation plans for patients admitted to medically stabilised beds in Singleton Hospital.
Methods: Two Plan-Do-Study-Act (PDSA) cycles were conducted: baseline project in July-August 2023 involving 34 patients and post-intervention project in October-November 2023 with 16 patients. Demographics data, Clinical Frailty Scores (CFS) and Charlson Comorbidity Index (CCI) and DNACPR status were collected. The intervention included introducing educational materials on medical wards and incorporating DNACPR status into patient handovers.
Results: 74% of patients had DNACPR plan in the pre-intervention group (who had mean age of 79 years, mean CFS 5.6, mean CCI 5.5). After intervention, a 7% improvement in DNACPR completion rate was observed. DNACPR plan was completed in 81% of patients (who had mean age of 80 years, mean CFS 5.75, mean CCI 5.6).
Conclusion: Whilst this initiative demonstrated an improvement in advanced care planning, 19% of patients in the post-intervention cycle still lacked appropriate escalation plans. Despite its limitations, this project raised awareness of health care professionals on DNACPR and ceiling-of-care decisions for frail elderly patients.