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Influence of guidelines on CPR decisions: an audit of clerking proforma

Paul Diggory, Lisa Shire, David Griffith, Valerie Jones, Enas Lawrence, Anand Mehta, Paul O'Mahony and Jane Vigus
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DOI: https://doi.org/10.7861/clinmedicine.4-5-424
Clin Med September 2004
Paul Diggory
∗Department of Elderly Care Medicine Mayday University Hospital, Croydon
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Lisa Shire
∗Department of Elderly Care Medicine Mayday University Hospital, Croydon
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David Griffith
∗Department of Elderly Care Medicine Mayday University Hospital, Croydon
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Valerie Jones
∗Department of Elderly Care Medicine Mayday University Hospital, Croydon
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Enas Lawrence
∗Department of Elderly Care Medicine Mayday University Hospital, Croydon
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Anand Mehta
∗Department of Elderly Care Medicine Mayday University Hospital, Croydon
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Paul O'Mahony
∗Department of Elderly Care Medicine Mayday University Hospital, Croydon
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Jane Vigus
∗Department of Elderly Care Medicine Mayday University Hospital, Croydon
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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.

Key Words
  • cardiopulmonary resuscitation
  • DNAR
  • guidelines
  • proforma
  • © 2004 Royal College of Physicians
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Influence of guidelines on CPR decisions
Paul Diggory, Lisa Shire, David Griffith, Valerie Jones, Enas Lawrence, Anand Mehta, Paul O'Mahony, Jane Vigus
Clinical Medicine Sep 2004, 4 (5) 424-426; DOI: 10.7861/clinmedicine.4-5-424

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Influence of guidelines on CPR decisions
Paul Diggory, Lisa Shire, David Griffith, Valerie Jones, Enas Lawrence, Anand Mehta, Paul O'Mahony, Jane Vigus
Clinical Medicine Sep 2004, 4 (5) 424-426; DOI: 10.7861/clinmedicine.4-5-424
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