The influence of new guidelines on cardiopulmonary resuscitation (CPR) decisions. Five cycles of audit of a clerk proforma which included a resuscitation decision

Resuscitation. 2003 Feb;56(2):159-65. doi: 10.1016/s0300-9572(02)00349-0.

Abstract

Current guidelines advise discussion with patients before issuing a 'do not attempt resuscitation' (DNAR) order. We report five audit cycles of cardiopulmonary resuscitation (CPR) documentation after introducing a proforma, the last cycle following the latest guidelines. In first audit data were collected from 75 patient discharges. CPR decisions were documented in 27 (36%). Four subsequent point prevalence audits carried out on all inpatients following proforma introduction showed documentation improved to 102/109 (94%), 135/148 (91%), 131/140 (94%) and 102/119 (86%) in cycles two, three, four and five, respectively. The last three audits also revealed that consultants consistently made more DNAR orders than trainee doctors. However, following the introduction of the latest guidelines the proportion of patients in whom a decision was made, and the percentage of those decisions that were DNAR, fell.

Publication types

  • Comparative Study

MeSH terms

  • Cardiopulmonary Resuscitation / standards*
  • Cardiopulmonary Resuscitation / trends
  • Decision Making
  • Emergency Service, Hospital / standards*
  • Emergency Service, Hospital / trends
  • Female
  • Guideline Adherence
  • Heart Arrest / mortality
  • Heart Arrest / therapy*
  • Humans
  • Intensive Care Units / standards*
  • Intensive Care Units / trends
  • Male
  • Medical Audit*
  • Practice Guidelines as Topic*
  • Quality of Health Care
  • Resuscitation Orders*
  • Survival Analysis
  • United Kingdom