title: The influence of new guidelines on cardiopulmonary resuscitation (CPR) decisions. Five cycles of audit of a clerk proforma which included a resuscitation decision.
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.
authors.affiliation: Department of Medicine for the Elderly, Mayday University Hospital, Croydon, London, UK. paul.diggory@mayday.nhs.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Diggory
authors.forename: Lisa
authors.initials: L
authors.lastname: Cauchi
authors.forename: David
authors.initials: D
authors.lastname: Griffith
authors.forename: Valerie
authors.initials: V
authors.lastname: Jones
authors.forename: Enas
authors.initials: E
authors.lastname: Lawrence
authors.forename: Anand
authors.initials: A
authors.lastname: Mehta
authors.forename: Paul
authors.initials: P
authors.lastname: O'Mahony
authors.forename: Jane
authors.initials: J
authors.lastname: Vigus
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000592:standards* / Q000639:trends; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000592:standards* / Q000639:trends; D005260:Female; D019983:Guideline Adherence; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards* / Q000639:trends; D008297:Male; D008485:Medical Audit; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D016414:Resuscitation Orders; D016019:Survival Analysis; D006113:United Kingdom