P-93 Standards for documentation of dnacpr decisions and discussions in a hospice inpatient unit & community team

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Abstract

Background

Recent legal cases have clarified requirements for good practice around documentation and communication of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions particuarly where it is clear in advance that CPR will not work for a patient. UK good practice guidance was updated in 2014 and further revised in 2016 to reflect the legal changes, and the NHS Scotland DNACPR integrated adult policy has also been reviewed.

Aim

To assess the documentation of DNACPR decisions by inpatient and community specialsit palliative care teams in relation to the updated NHS Scotland policy to highlight the areas where education should be targeted. The audit standards are based on the revised UK good practice guidance and aspects of a measurement framework developed by Health Improvement Scotland as part of the Deteriorating Patient workstrands.

Methods

A retrospective audit was completed of 20 hospice inpatient unit (IPU) notes and 20 consecutive community team (CT)referrals. Compliance with 5 documentation standards was assessed for: individualised decision-making; correct DNACPR form completion; patient involvement; and good practice around incapacity.

Results

16/20 inpatients and 7/20 community patients already had a DNACPR form in place on admission to the service. Compliance with good practice standards for discussion and documentation was excellent apart form; documentation of review timeframe (40%) for inpatients; and documentation of discussion when CPR was a realistic treatment option - only one of the 7 patients for who CPR might work had documented evidence that a discussion had taken place.

Conclusion

Patients coming into contact with the IPU or CT generally encounter good practice with regards to discussion and documentation of a clinical DNACPR decision. However community patients for whom CPR might work are less likely to be given the option to discuss their choices highlighting an education need for palliative care specialists.

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