Purchase PDF (339 K) | Staff awareness of a `Do Not Attempt Resuscitation' pol... Resuscitation |
  Staff awareness of a ‘Do Not Attempt Resuscitation’ policy in a District General HospitalResuscitation, Volume 65, Issue 2, May 2005, Pages 159-163 Gary B. Smith, Nicola Poplett, Derek Williams Abstract UK hospitals have been instructed to ensure that all staff understand the institution's resuscitation policy. Using a questionnaire, we determined the level of knowledge about the hospital's ‘do not attempt resuscitation’ (DNAR) policy amongst a range of staff. Six hundred and seventy-seven questionnaires were returned. 91.4%of responders did not know the correct overall percentage survival to hospital discharge following an in-hospital cardiac arrest. 19.3%of doctors, 10.6%of nurses, and 8.9%of health care support workers (HCSW) gave answers in the correct range (i.e., 15–25%). Most doctors (93.5%), nurses (93.5%), and HCSW (78.9%) correctly identified that cardiopulmonary resuscitation (CPR) should be the default position, when a DNAR decision does not exist. The majority of doctors (78.5%), nurses (73.2%) and HCSW (65.8%) appreciated that the hospital policy allowed a senior trainee doctor (specialist registrar; SpR) to make the initial decision without consultation with more senior medical staff. Knowledge of who was ultimately responsible for the DNAR decision was also good, with 100%of doctors, 100%of midwives, 98.3%of nurses and 78.9%of HCSW responding correctly. Ten percent of doctors, 15%of nurses and 10.5%of HCSW believed that the next of kin could demand resuscitation or a DNAR status. There was inconsistency about what information staff felt should be included in DNAR documentation and what, if any, continuing care should be given to patients who are not for resuscitation. Our study demonstrates that there is room for improvement in the awareness of staff about the DNAR process. The local DNAR policy is being reviewed to ensure that its messages are clear and a specific DNAR educational programme has been commenced. Purchase PDF (65 K) |
| Improving decision Resuscitation |
| Improving decision Resuscitation, Volume 57, Issue 2, May 2003, Pages 139-144 J. V. Butler, P. K. Pooviah, D. Cunningham, M. Hasan Abstract Introduction: Do not attempt resuscitation (DNAR) decision-making and recording in case notes can be poor. We have audited current practices pertaining to DNAR orders in a district hospital before and after the introduction of a standardised order form (SOF). Methodology: DNAR decisions in medical case notes were audited before and after the introduction of a SOF. All aspects of the decision were scrutinised against recommended guidelines (BMA/RCN/RC (UK) London: BMA, 1999). Results: Case notes of 156 patients were examined. A total of 62 (39.7%) had combined case note and SOF documentation (Gp1), while 94 (60.3%) had case note documentation only (Gp2). Some 61/62 (98.4%) of DNAR indications in Gp1 were in accordance with guidelines versus 81/94 (86.2%) in GP2 (P<0.01) and 50/62 (80.6%) of decisions were reviewed in GP1 versus 36/94 (38.3%) in GP2 (P<0.001). More decisions were authorised by consultants in GP1 (56/62 (90.3%) vs. 35/94 (37.2%) P<0.001) and had active patient participation (9/62 (14.5%) vs. 1/94 (1.1%) P<0.001) compared with Gp2. Conclusion: Documentation of DNAR decisions in medical case notes is poor. Standardised order forms, based on recommended national guidelines that complement case note entries, improve the process and recording of this sensitive decision. AbstractIntrodução: A decisão de não reanimar (DNRA) e o registo dessa decisão em notas apropriadas pode ser escasso. Foi auditada a prática corrente relativamente a ordens DNAR num hospital distrital antes e após a introdução de um Modelo de Ordens Uniforme (SOF). Metodologia: As decisões DNAR nas notas médicas foram auditadas antes e após a introdução do SOF. Todos os aspectos da decisão foram escrutinados de acordo com as guidelines recomendadas (BMA/ RCN / RC (UK) Londres: BMA, 1999). Resultados: Foram examinadas as notas de 156 pacientes. Um total de 62 (39.7%) tinham documentação em notas médicas e SOF (Gp1), enquanto 94 (60.3%) tinham apenas documentação nas notas médicas (Gp2). Algumas 61/62 (98.4%) das indicações DNAR no Gp1 estavam de acordo com as guidelines versus 81/94 (86.2%) no Gp2 (P<0.01) e 50/60 (80.6%) das decisões foram revistas no Gp1 versus 36/94 (38.3%) no Gp 2 (P<0.001). Foi autorizado um maior número de decisões por especialistas no Gp1 (56/62 (90.3%) vs 35/94 (37.2%) P<0.001) e neste grupo também existiu uma maior participação activa dos pacientes que no Gp2. Conclusão: A documentação das decisões DNAR nos registos diários médicos é pobre. Os SOF, baseados em guidelines recomendadas nacionais que complementam estes registos nas notas médicas, melhoram o processo e o registo destas decisões sensíveis.ResumenIntroducción: La toma de decisión de no intentar resucitación (DNAR) y su registro en las notas de casos puede ser pobre. Realizamos una auditoría a las practicas actuales con relación a órdenes de DNAR en un hospital distrital antes y después de introducir un formulario estandarizado para esa orden (SOF). Metodología: Las decisiones de DNAR en las notas de casos médicos fueron revisadas antes y después de la introducción de SOF. Todos los aspectos de la decisión fueron examinados en detalle comparándolos con las guías recomendadas (BMA/RCN/RC(UK) London; BMA, 1999). Resultados: Se examinaron las notas de los casos de 156 pacientes. Un total de 62 (39.7%) tenían combinación de notas del caso y documentación SOF (Gpl), mientras 94 (60.3%) tenían solo documentación de notas del caso (Gp2). 61/62 (98.4%) de las indicaciones de DNAR en el GP1 estaban de acuerdo con las guías, versus 81/94 (86.2%) en el GP2 (P<0.01) y 50/62 (80.6%) de las decisiones fueron revisadas en el GP1 versus 36/94 (38.3%) en GP2 (P<0.001). En GP1 hubieron mas decisiones autorizadas por consultores (56/62 (90.3%) vs. 35/94 (37.2%) P<0.001) y mas de estas decisiones tuvieron participación activa del paciente (9/62 (14.5%) vs 1/94 (1.1%) P<0.001) comparados con GP2. Conclusión: La documentación de decisiones de DNAR en notas de casos médicos es pobre. Los formularios estandarizados de orden, basados en guías de recomendaciones nacionales que complementan las anotaciones en las notas de casos, mejoran el proceso y registro de esta delicada decisión. Purchase PDF (213 K) |
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doi:10.1016/j.resuscitation.2008.03.084 
Staff knowledge survey of a hospital Do Not Attempt Resuscitation (DNAR) policy: Is this policy effective and is the documentation completed accurately?
