Abstract
DNAR QIP abstract
Introduction: Advanced Care Planning (ACP) involves making decisions about future care, including resuscitation. When resuscitation is deemed not in a patient’s best interest, a Do Not Attempt Resuscitation (DNAR) order is made to prevent harm. NHS England recommends that ACP decisions be shareable as this improves efficiency of repeated discussions and ensures patients’ wishes are respected. In Wales there is no consistently used ACP documents which increases risk of unwanted management as well as inconsistency in the ACP documentation.
Methods: This study aimed to improve communication of resuscitation status in electronic discharge letters. Baseline data were collected, followed by two PDSA (Plan-Do-Study-Act) cycles. In Cycle 1, posters prompted doctors to include resuscitation decisions in discharge letters. Cycle 2 utilised a teaching session on resuscitation status and ACP planning to educate resident doctors. Resuscitation status was gathered from medical and nursing notes, and discharge letters were reviewed post-intervention.
Results: At baseline 61 patient notes were reviewed - 44% had a DNAR decision, of which 26% were documented in discharge letters. In Cycle 1 16 doctors were exposed to the posters. 51 patient notes were reviewed - 45% had a DNAR decision, of with 40% documented in discharge letters. In Cycle 2 five doctors attended the teaching session. 61 patient notes were reviewed - 41% had a DNAR decision of which 29% were documented in discharge letters.
Conclusion: Communication of DNAR status in discharge letters is poor. Poster prompts showed initial improvement, but this was not sustained. Contributing factors included staff rotation and time constraints. Lower engagement in Cycle 2 may have reduced its impact. Future efforts should include multiple teaching sessions to reach more resident doctors. Longer term interventions could target non-rotational staff such Consultants to give them more oversight to discharge advice letters and encourage the inclusion of ACP decisions.