61ELECTRONIC DO NOT ATTEMPT CARDIO-PULMONARY RESUSCITATION (DNACPR): TOO FAR? AN EVALUATION OF PRACTICE WITHIN GERONTOLOGY AT KING’S COLLEGE HOSPITAL (KCH), LONDON, UK

Abstract

Introduction: DNACPR decisions are an ethical and legal challenge (Fritz, Slowther & Perkins. BMJ2017;356:813) with great emphasis placed on quality communication, decision-making and documentation for patient safety (BMA Resuscouncil, 2014). Following the introduction of a DNACPR toolbar within electronic records (Johnson, Whyte, Loveridge. BMJ2017;6), and a staff-survey demonstrating uncertainty around resuscitation, our study aimed to evaluate practice. Method(s): A completed loop audit was performed within gerontology between January- June 2018. Data was collected prospectively weekly over a month, including all with a DNACPR, with discharges analysed retrospectively. Result(s): First cycle, all 181 patients had a resuscitation status; 73% had a DNACPR decision. 100% had a treatment escalation plan (TEP), 85% had a valid explanatory form, but 15% were absent. 86% were made by a senior doctor. 68% evidenced discussions with patients/relatives, and 13% had documented MDT discussion. 88 patients were discharged; 39% of which had a DNACPR. 79% were communicated in discharge letters within a comprehensive geriatric assessment (CGA). Following interventions, performance improved in all areas. All 176 patients had a resuscitation status, with 72% having a DNACPR decision. 100% of these had a TEP and valid form. 93% were made by a senior doctor. 71% evidenced a discussion with patients/relatives with 57% having a documented MDT discussion. Conclusion(s): A key finding was poor communication, increasing risk of inappropriate resuscitation. Interventions demonstrated improvement, which should reduce the risk of harm and encourages a patient centred approach. The e-toolbar remains an effective prompt for making timely decisions. Revision of electronic processes and staff training led to improved documentation. We recommend the inclusion of DNACPR decisions in discharge letters via CGAs, as it improves co-ordination of care with the community. This tool is being applied trust-wide evaluating other divisions. Overall, this highlights the importance of ensuring e-systems are legally compliant with trust policy, and encouraging cultural change to impact patient safety.