Abstract
Introduction:
DNACPR documentation is an important component of clinical practice and guides decision making in the event of a cardiac arrest. A thorough documentation reflects the rationale behind the decision and states whether patient and family are aware and in agreement. Incomplete documentation fails to justify the DNACPR decision and demonstrate effective communication.
Objective:
To increase compliance with the completion of DNACPR documentation ensuring that each form achieves a high standard of completion – defined as at least 80% of the form being completed.
Methods:
A Plan-Do-Study- Act (PDSA) methodology was employed. Baseline data was collected retrospectively from clinical records. Following data analysis, change strategies were implemented, and data was collected in two subsequent cycles to assess improvement and sustainability.
Change Ideas and Implementation:
A presentation was delivered in the departmental meeting that aimed to raise awareness on the significance of completion of DNACPR documentation. Attendees were educated on General Medical Council (GMC) and Resuscitation Council UK (RCUK) guidelines on DNACPR decision making and documentation. Data analysis was shared and gaps in documentation were highlighted. Posters were displayed to reinforce good practice.
Results:
The interventions led to a sustained improvement in the quality of DNACPR documentation. By the third cycle of data collection the percentage of forms with at least 80% completion increased from 50% to 72%. Additionally, a higher standard of 90% completion increased from 18% to 36%.
Conclusion:
The project demonstrates the effectiveness of targeted education and visual reminders in improving clinical documentation and practices. Quality Improvement is an ongoing process. It is important to identify areas that need improvement and take initiative to promote positive changes. Educating health care professionals and raising awareness about the problems and possible solutions is crucial to Quality Improvement Projects in a health care setting. Posters are a useful tool for the same.
Comments
Important topic in clinical practice
A well-executed QI project addressing an essential aspect of safe and ethical clinical practice. The use of education, guideline reinforcement, and visual prompts led to clear, sustained improvement in DNACPR documentation quality. Strong methodology and great demonstration of how simple, targeted interventions can enhance compliance and communication standards.
Using presentation as a tool for improvement:
Thank you. I believe that presenting not only the data analysis but also the practical significance of good documentation and educating on guidelines made a substantial difference. The presentation encouraged meaningful interaction from both senior and resident doctors, which led to lasting impact on practice.
Advanced care planning
This a very important topic in geriatric medicine and clearly educational interventions have resulted in a direct increase in DNACPR documentation. Do you know if these interventions also led to an increase in general documentation of advanced care planning (ACP), and sparked further conversations around ACP? I am not familiar with your trust, but we use RESPECT forms where both DNACPR and ACP discussions are recorded on the same document - this is very useful to achieve not only DNACPR documentation but encourage health professionals to discuss ACP.
Project Scope and Future Applications:
Thank you for your comment. While this project focused specifically on DNACPR documentation, the improvement strategies could certainly be applied to discussions and documentation of advanced care and treatment escalation plans. Your point about combined forms like RESPECT is very helpful and could guide such future initiatives.