271 Introducing a ‘Do Not Attempt CPR’ and ‘Treatment Escalation Plan’ Form to Improve Patient Care and Decision Making

Abstract

Background The HSE National Consent Policy recommends health care professionals ‘develop specific mechanisms for the documentation and dissemination of decisions relating to resuscitation’. We also felt a need to promote a move away from a unidimensional CPR focus more towards documentation of appropriate and inappropriate care for the individual patient. Methods In December 2018 we conducted a baseline study of the quality of documentation of patient resuscitation and escalation plans in our hospital. We reviewed the charts of patients on 4 wards on a single day. Results Of 80 patients, 19 had some documentation regarding a CPR discussion. Of those 19 one had been determined at time of an arrest call and one at the time of a deterioration. Only 13 of 19 had some documentation of a discussion surrounding the decision. Only 5 had any documentation of the reasoning behind the decision. Conclusion Other hospitals in our hospital group had implemented a `Do Not Attempt CPR' and Treatment Escalation Plan form in the last year. With their permission we used their form as a template to develop a form for use across our hospital .This form is to be readily accessible in an emergency and out of hours, and contains quality information regarding the goals of care for an individual patient. The form is a single page, easily identifiable with a red border and filed inside the front cover of the chart. We have had the form approved by our Lead Clinicians forum and Hospital’s Resus Committee. To promote the successful introduction of the form we have conducted education sessions across the departments of Medicine, Surgery, Anaesthesia and Obstetrics and Gynaecology. The form has is currently being printed and will be implemented in the coming weeks. We will be closely liaising with users and reviewing its use following implementation.