PT  - JOURNAL ARTICLE
AU  - Paul Diggory
AU  - Lisa Shire
AU  - David Griffith
AU  - Valerie Jones
AU  - Enas Lawrence
AU  - Anand Mehta
AU  - Paul O'Mahony
AU  - Jane Vigus
TI  - Influence of guidelines on CPR decisions: an audit of clerking proforma
AID  - 10.7861/clinmedicine.4-5-424
DP  - 2004 Sep 01
TA  - Clinical Medicine
PG  - 424--426
VI  - 4
IP  - 5
4099  - http://www.rcpjournals.org/content/4/5/424.short
4100  - http://www.rcpjournals.org/content/4/5/424.full
SO  - Clin Med2004 Sep 01; 4
AB  - 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.