From paper to paperless: Do electronic systems ensure safe and effective communication and documentation of DNACPR decisions?

Abstract

Introduction An electronic resuscitation system, implemented in 2015, within electronic patient records (EPR) at King's College Hospital NHS Foundation Trust was studied, aiming to review and improve decision documentation and communication. Method The study (January 2018 – June 2018) included all gerontology inpatients with electronic do not attempt cardiopulmonary resuscitation (e-DNACPR) decisions. Cases were identified weekly, followed by retrospective analysis of discharges. Amendments to the electronic system and improvements were implemented between cycles. Cycle 1 One-hundred and thirty-three patients were included; 85% had an e-DNACPR form; 86% of all forms had senior doctor involvement; 68% evidenced patient/relative discussion; 13% documented multidisciplinary team (MDT) discussion. Interventions A mandatory ‘named nurse’ field was added to the form and trust-wide education programme implemented. Cycle 2 One-hundred and twenty-six patients were included; 100% had an e-DNACPR form; 93% evidenced senior doctor involvement; 71% evidenced patient/relative discussion; 57% documented MDT discussion. Conclusion Changes to the process and trust-wide education resulted in more robust documentation and communication.