BIOGRAPHY
I am a medical registrar with a passion for medical education, and quality and service improvement initiatives. I am currently working at Sir Charles Gairdner Hospital, Perth, WA, in General Medicine, having initially trained in London, as a medical registrar. I wish to pursue a career in geriatric medicine. ABSTRACT
Do Not Avoid Resuscitation Status
Authors: S. Sinha-Roy1, L. Buters1, J. Patel1, M. Skinner1
Affiliations: 1 Sir Charles Gairdner Hospital, Department of General Medicine, Perth,
Western Australia.
Aims: Patients are most likely to experience clinical deterioration within the first 24 hours of their admission (1). Survival after in-hospital cardiac arrest is less than 5% in patients with multiple co-morbidities (2).
This study aimed to improve the documentation and use of Do Not Attempt Resuscitation (DNAR) forms in the Medical Admissions Unit (MAU), through educational sessions and feedback.
Methods: Criteria as outlined by the Western Australia (WA) Department of Health that confer poor Cardio-Pulmonary Resuscitation (CPR) survival were used to identify patients for whom a DNAR form would be appropriate.
Baseline data on the completion of DNAR forms in the MAU was collected for seven consecutive weeks between August and October 2014, with the results fed back to the department.
Education sessions on patient criteria that indicated poor CPR survival, and communication frameworks to discuss resuscitation status with patients were provided to junior doctors from March to August 2015.
Patient notes were re-audited over the same time period in 2015, with demographic data on all completed DNAR forms recorded.
Results: In 2014, 69 patients met the criteria for a DNAR form but only 51% had one completed. In 2015, 68 patients met the criteria for a DNAR form and 84% had one completed, demonstrating an improved completion rate of DNAR forms (p=0.048). All completed forms met the WA Department of Health patient criteria for poor CPR survival.
Conclusion: Tailored education sessions with regular feedback can lead to improved completion of DNAR forms, avoiding unwanted CPR attempts.
References:
1. Jones DA, et al. Mortality of rapid response team patients in Australia: A
Multicentre study. ANZICS MET dose investigators. Critical Care and Resuscitation; 15:4 (2013)
2. Meaney PA, et al. Rhythms and outcomes of adult in-hospital cardiac arrest.
Critical Care Medicine; 38:101-8 (2010)
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