Cardio Pulmonary Resuscitation Decisions in Nursing Home Residents

Abstract

Objective: Cardiopulmonary resuscitation (CPR) performed on nursing home residents, consistently demonstrates poor outcomes with less than 5% survival rate (AMDA, January 30, 2011). Study participants overestimate CPR survival based on television and lack of accurate information (Adams & Snedden, 2006;van Mil et al., 2000). This project evaluated use of a video decision tool on CPR choices in nursing home residents over three months. Methods:A CPR video decision tool was added to advance care planning discussions as an audiovisual component to educate nursing home residents and their decision makers.Nurse Practitioners (NPs) documented the resident's choices in the electronic health record (EHR). Clinical metric reports, based on the EHR, were used to measure the change in CPR decisions over three months in seven nursing homes.Significance: Health care spending is disproportionate at the end of life-30% of Medicare expenditures are attributed to 5% of beneficiaries who die annually and 78% of costs are incurred in the final 30 days of life (Yu, 2008). Studies indicate a reduction in hospitalizations by increasing the use of advanced directives, surrogate decision makers and do not resuscitate decisions (Levy, Morris & Kramer, 2008;Molloy et al. 2000;and Nicholas, Langa, Iwashyna & Weir, 2011). Integration of a CPR video tool (Nous Foundation, 2010) into advance care planning, has the potential to reduce hospitalizations and health care costs, and ensure end of life care is consistent with resident wishes (Aw et al., 2012). Results:The mean percentage change following implementation of the CPR video tool was 5.5% with p=.226. One facility closed during the pilot, one facility with a new NP showed an increase in residents requesting CPR and one of the eight facilities showed no change. The decrease in residents requesting CPR was not statistically signficant following integration of the CPR video tool. Despite the lack of statistical significance, a 5.5% reduction in residents selecting CPR with an equivalent reduction in hospitalizations would reduce medical expenses by $56,987.Keywords: CPR; Nursing Home; Video Decision Tool -3 - Appendix J Post Implementation Call Log 88-5 - Tables Table 1 Critical Apprisal of Evidence 16 Table 2 AGREE Guideline Evaluation 16 Table 3 Rapid Critical Appraisal of Systematic Review 18 Table 4 Recommendations with Levels of Effectiveness 27 Table 5 Evidence Synthesis 30 Table 6 Timeline for Project Implementation 32 Table 7 Descriptive Statistics 38 Table 8 Tests of Between Subjects Effects 38 List of List of Figures SummaryThe proposed integration of a video CPR decision tool into the existing advance care planning discussions between the nurse practitioners, nursing home residents and their decision makers is projected to reduce the number of residents requesting CPR to less than the current 36.7% as a primary direct outcome measurement. Theoretical Framework-Organizational Process ChangeThe Rosswurm and Larrabee (1999) model for evidence-based practice change em...