Improving the consideration of resuscitation status and electronic upload of Do Not Resuscitate forms in an orthogeriatric ward

4408
Alexander Mackay
Forth Valley Royal Hospital
Clinical Quality Research
CQ - Clinical Effectiveness
Treatment escalation plans
View DOI

Abstract

Introduction

Resuscitation status is frequently not considered, resulting in CPR being performed when it may not be in a patient’s best interests and limiting opportunities for patients/families to express their wishes. Even when a do not resuscitate (DNR) decision is made, forms are not always uploaded to electronic systems, leading to repeated discussions and periods during readmission when no DNR is in place.

Aim: This QI project in the orthogeriatric department at Forth Valley Royal Hospital (FVRH) aimed to:

  1. Increase consideration of resuscitation status to >90% of patients.
  2. Increase the proportion of DNR forms uploaded to Clinical Portal (the electronic system used in FVRH)

 

Methods

Interventions: Highlighting patients without documented resuscitation decisions on the MDT board and paper handovers, flagging completed DNR forms for upload, staff education on how to upload DNRs, staff were advised to check DNR forms were uploaded prior to discharge. From week 8, outstanding resuscitation decisions were raised during MDT meetings.

Data collection: Over 17 weeks, inpatient notes were reviewed weekly to assess if resuscitation had been considered (no data collected weeks 6, 10, and 11). Following discharge, data from 54 patients pre-intervention and 73 post-intervention were compared to assess the proportion of DNR forms uploaded to Clinical Portal.

 

Results

Consideration of resuscitation status quickly increased from a baseline of 74%, to 100% in week 4. There was a dip to 85% in week 8 but this subsequently improved.  Overall a median of 98.5% of resuscitation consideration was achieved. Uploading of DNR forms to Clinical Portal rose from 67% pre-intervention to 96% post-intervention.

 

Conclusion

The QI project achieved its stated aims with simple changes which are easily reproducible across any ward. To ensure these changes ‘stuck’, outstanding resuscitation decisions were highlighted during MDT meetings to provide a system change more resilient to staff fatigue.

Comments

I like this project as it is an important aspect of care that is often missed. I also like that you followed this up for a number of weeks to ensure change was maintained

Is this something that can spread to other wards and departments?

Submitted by ennanm_20365 on

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Thanks for your comment.

Yes I think it is something that could be easily spread across multiple wards, none of the changes were complicated or difficult to implement. The only challenge would be in encouraging people to stick to the interventions, for this I think each ward would require someone to be pushing this forward initially until the changes became part of practice. 

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