title: Influence of guidelines on CPR decisions: an audit of clerking proforma.
abstract: We audited documentation rates and implementation of cardiopulmonary resuscitation (CPR) decisions for patients admitted under the Department of Elderly Care Medicine, Mayday University Hospital, Croydon, as new guidelines and a proforma were introduced. For the first audit, data were collected from 75 departmental discharges. Following introduction of a proforma, six point prevalence audits were performed of all elderly care inpatients. Consultant documentation improved from 27/75 (36%) to 102/109 (94%), 135/148 (91%), 133/140 (95%), 96/119 (81%), 148/157 (94%) and 167/169 (98%) in audits 2, 3, 4, 5, 6 and 7 respectively. The percentages of decisions that were Do Not Attempt Resuscitation (DNAR) were 64% 72%, 45%, 68% and 62% in audits 3 to 7 respectively. For audit 5 our guidelines required discussion with patient before making a DNAR order, whereas the guidelines applicable for the other audits did not stipulate discussion. The fall in documentation rates and proportion of CPR decisions that were DNAR in audit 5 were statistically significant. There was no significant difference in age, diagnosis, cognitive function or disability between patients in those audits (3-7) when these parameters were recorded. Introducing a proforma significantly improved CPR decision documentation. Obligatory discussion with a patient before issuing a DNAR order was associated with a fall in documentation of decisions.
authors.affiliation: Department of Elderly Care Medicine, Mayday University Hospital, Croydon. Paul.diggory@mayday.nhs.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Diggory
authors.forename: Lisa
authors.initials: L
authors.lastname: Shire
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: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000941:ethics / Q000592:standards; D003657:Decision Making / Q000941:ethics; D006801:Humans; D008485:Medical Audit; D016414:Resuscitation Orders