Code status discussions and goals of care among hospitalised adults

Abstract

Doctors need to address patients' knowledge about CPR and take steps to avoid discrepancies between treatment orders and patients' preferences. Addressing CPR outcome probabilities and goals of care during code status discussions may improve patients' knowledge and influence their preferences.

Patients' characteristics associated with the decision of “do not attempt cardiopulmonary resuscitation” order in a Swiss hospital

“…This data is not published in the literature, but the prevalence of the discussion of the resuscitation order with patients and/or relatives varied considerably (10-84%) according to the country [15,20,21]. The fact that about a quarter of the patients lack capacity to consent to treatment in the first 72 h after admission at the hospital [27] could explain a part of the important number of medical decisions.…”

“…Several factors are associated with the DNACPR order: older age [7,12,16,17], presence of several comorbidities [12,[17][18][19], oncologic status [7,12,19], psychiatric disease [7], poor quality of life [7,17] and poor prognostic [7,17]. Despite the common consensus about patient implication in the decision of establishing a DNACPR order, the prevalence of the discussion of this order with patients and/or relatives varied considerably (10-84%) according to the country [15,20,21]. Although many Swiss hospitals have mandatory instructions to obtain a reanimation code upon admission to the hospital, little is known about how this decision is made, and which are the main factors influencing this decision.…”

Strategies for Improving Survival After In-Hospital Cardiac Arrest in the United States: 2013 Consensus Recommendations

“…It is important to be frank with the patient and explain the probability of surviving IHCA, because most older patients readily understand prognostic information and can make decisions on whether they would like to receive CPR. [63][64][65] The DNAR order should preferably state either full resuscitation or no attempt at resuscitation; however, certain situations or patient or family preferences may warrant explicit instructions about which interventions to withhold or provide (eg, CPR without intubation, medications without CPR). This may include but is not limited to vasopressor agents, blood products, advanced airway interventions, nutrition, fluids, analgesia, sedation, antiarrhythmic drugs, and defibrillation.…”

Raising The Standard: Palliative Care In Nursing Homes

“…Patients and families report better quality of care and quality of life as a result of such discussions. [14][15][16] Second, because front-line providers are crucial to quality of care of residents, staff turnover and consistency of providers should be measured. These are not included in current or planned nursing home quality measure sets.…”