G Sanders1; V Inpadhas1; S Hamid1

1. Department of Elderly Care; Colchester Hospital; East Suffolk and North Essex NHS Foundation Trust.

Abstract

Background:

Delays in documenting a valid DNACPR (Do not attempt cardiopulmonary resuscitation) form in medical notes, for patients with advanced decisions, presses the cardiac arrest team to make difficult decisions about resuscitation, with little time to establish the patient’s wishes. This removes the right, for some patients, to die with dignity and peacefully. Local policy states patients with DNACPR forms should have this reviewed by the senior clinician in charge of their care as soon as is possible.

Aim:

To reduce the percentage of geriatric patients in Colchester hospital (with electronic DNACPR decisions) at 24 hours post admission without a signed DNACPR form in their notes to 30% from baseline of 44%. Methods: Baseline data was collected from geriatric wards on five dates in August and September 2021(n=122). For each patient, two online systems were reviewed (Evolve and My Care Choices Record) to locate existing indefinite DNACPR decisions. For these patients (n=25), the number of days between admission date and signed on the DNACPR form in medical notes was calculated. Ethics approval was gathered prior to data collection. Interventions: Posters in clerking locations, messages in doctors Whatsapp groups and presenting our first audit cycle at grand round. Re-audit was performed on three dates in June, July and August 2022 to see if our aim had been achieved.

Results:

Re-audit (n=98) proved reduction in the percentage of patients with a pre-existing DNACPR decision (n=30) at 24 hours post admission without a signed DNACPR form to 30%. In both cycles, 80% of patients with advanced decisions had a physical copy reinstated in their medical notes by 48 hours of admission.

Conclusions:

Further improvements are required to protect all patients from untimely DNACPR reviews. Audit results should be shared with colleagues to evidence the impact on patients and create motivation for behavioural change.