Pre-printed 'do not attempt resuscitation' forms improve documentation?
OBJECTIVE
Do not-attempt-resuscitate orders are fundamental for allowing patients to die peacefully without inappropriate resuscitation attempts. Once the decision has been made it is imperative to record this information accurately. However, during a related research projected we noted that documentation was poor and we thought that the introduction of a pre-printed Do Not Attempt Resuscitation (DNAR) form would improve the documentation process.


METHODS
Two sets of identical research questions were applied retrospectively, 12-months apart, to notes of adult patients (>18 years) who had died during a hospital admission without under-going a resuscitation attempt. Between the first and the second audit, a new resuscitation policy that incorporated a pre-printed DNAR form was introduced into our hospital.


RESULTS
A pre-printed DNAR form improved documentation when measured against; clarity of DNAR order (P=0.05), date decision was made/implementation (P=0.014), presence of clinician's signature (P=0.001), identification of the senior clinician making the decision (P< or =0.001) and justification for the DNAR decision (P< or =0.001). However, the pre-printed form made little improvement in encouraging patient involvement in the DNAR decision-making process (P=0.348).


CONCLUSIONS
A pre-printed DNAR form can improve documentation significantly but it has little effect in encouraging patient involvement in the decision-making process.
Castle
Nick
N
Nurse Consultant in Emergency Care, Frimley Park hospital, Portsmouth Road, Camberley, Surrey, UK. nic4healths@aol.com
Owen
Robert
R
Kenward
Gary
G
Ineson
N
N
D000293:Adolescent; D000328:Adult; D004282:Documentation / Q000379:methods*; D006801:Humans; D008485:Medical Audit; D010361:Patients / Q000523:psychology; D016414:Resuscitation Orders; D012189:Retrospective Studies