Challenging questions and ethical obligations: the ethics of everyday practice > 21 January 2015

Nibu Thomas, Katie Bishop, Joel Abbott, Ben Thomas, John Tobin, Gillian Bennett

Poster presenters

Abstract

DNACPR decisions: A regional study of communication and documentation of do not attempt resuscitation decisions

Background:
Cardiopulmonary resuscitation (CPR) was initially described in 1960s as a treatment following myocardial infarction on a coronary care ward.1 The use has expanded and was regarded as a treatment for all inpatients until 1976 when the first “order not to resuscitate” was described.2 Current UK guidelines state that decisions not to resuscitate should be made by healthcare professionals but that patients and relatives should be involved where possible and their wishes considered.3,4

Methods:
All Do Not Attempt CPR (DNACPR) forms submitted over a 6 month period across 3 hospital sites in North Wales were reviewed. Reason for not attempting CPR, whether the patient had capacity to understand the decision and whether this was communicated to the patient and relatives were all recorded. Medical records were further analysed to determine any further discussion of the decision.

Results:
1673 DNACPR decisions were made in the 6 month period. Of these 90% (n=1508) were documented as futile and 2.9% (n=48) due to patient refusal. 36.0% (n=599) patients had capacity to make decisions regarding CPR but only 42.4% of these (n=254) were involved in a discussion. 28.1% (n=168) decisions were not discussed with either patient or family and on review of case notes, 24.14% (n=21) of those not involved in the decision, had a documented terminal condition.

Conclusion:
End of life decisions can be complex and complicated by the public perception of its success rate. Patients with capacity to make decisions regarding resuscitation were not routinely involved in decision making- reasons for this were not well documented in patient medical records.   Most patients in our study were not thought to have capacity to make decisions regarding resuscitation- often because they were too unwell and in extremis. This suggests that these decisions could be more adequately made with better provision of advance care planning.

 

  1. Obolensky L, Clark T, Matthew G, et al. A patient and relative centred evaluation of treatment escalation plans: a replacement for the do-not-resuscitate process. J Med Ethics 2010 36: 518-520
  2. Rabkin MT, Gillerman G, Rice NR. Orders not to resuscitate. N Engl J Med. 1976;295:364e6
  3. Decisions relating to cardiopulmonary resuscitation A joint statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing. 2007. (Accessed 09 July 2014 at: http://www.resus.org.uk/pages/dnar.pdf)
  4. Decisions Relating To Cardiopulmonary Resuscitation: Guidance from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing. 2014 (Accessed 07 October 2014 at: www.resus.org.uk/pages/decisionsrelatingtocpr.pdf )

 

Biography

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