DNACPR: Are we discussing with patients and next of kin?

Introduction

Working on Tameside Geriatric medicine wards in the past year, we came across several patients who had a DNACPR form, their families/NOK were not aware and they lacked mental capacity themselves to understand. Some had capacity but it wasn't discussed with them which was shocking. We believe that a decision to with-hold life saving treatment is huge and there should be more conversation and documentation surrounding it.

Method

We collected data from the 2 specialized Geriatric Medicine wards using a data collection tool to see how many patients had DNACPR decisions discussed with them and/or informed to their NOK and then also how many of them had the discussion documented in their medical notes. We analysed and presented the data in 2 cycles at our local Grand Rounds as well as on the geriatric medicine wards. We also made a staff education poster.

Results

It was discovered across the 2 audit cycles that DNACPR discussions with patients went up from 40% to 50%; documentation of patient discussions improved from 37% to 70%, Informing NOK remained at 60% and Documentation of NOK being informed climbed from 75% to 83%.

Conclusion

As a result we explored reasons why DNACPRs are not discussed and what can be done to encourage it as well as how to become a hospital that does not shy away from difficult discussions, we also involved our Specialist Palliative Care Team as experts on discussing difficult topics, we presented and put up a staff education poster on all medical wards so that when we do this audit some other time on non-geriatric wards the outcomes are better. We also taught this to FY1s and Clinical Fellows. The learning from this Audit has been applied generally and we are happy with the improvement in the outcomes.