Comparison of not for resuscitation (NFR) forms across five Victorian health services

Abstract

NFR forms should be reviewed and standardised so as to be clear, uniform and consistent with the legislative framework. We propose a two-stage process of documentation. Stage 1 facilitates discussion of patient-specific goals of care and consideration of limitations of treatment. Stage 2 serves to communicate a NFR order. Decisions to withhold resuscitation are inherently complex but could be aided by separating the decision-making process from the communication of the decision, resulting in improved end-of-life care.

Use of resuscitation plans at a tertiary Australian hospital: room for improvement

“…3,4 Ensuring high-quality care at the end of life is a major focus of government healthcare agencies in Australia. [7][8][9][10] A resuscitation plan differs from an advance care plan, which is a statement of a person's preferences for future care that is usually centred on the person's values and is relatively stable. Used in many hospitals, resuscitation plans have had different titles, including 'Not for Resuscitation (NFR) Order', 'Resuscitation Management Plan', 'Limitation of Medical Therapy (LOMT)' order and 'Goals of Care Plan', and although providing advice about what to do if cardiac arrest was to occur is a common element, resuscitation plans are increasingly being used to also give advice about management of non-arrest problems.…”

Examining the preparation and ongoing support of adults to take their medications as prescribed in kidney transplantation

“…Additionally, this study was conducted in one state in Australia where variances elsewhere may be significant. This is not an isolated problem, with not for resuscitation orders at five Victorian health services also having wide variations requiring a standardized approach [22].…”

Testing a new form to document ‘Goals‐of‐Care’ discussions regarding plans for end‐of‐life care for patients in an Australian emergency department

“…We designed a two‐page GOC and Not‐for‐CPR (NFCPR) form. The form’s content arose from reviews of forms at multiple Australian hospitals . We felt that NFCPR documentation should be separate from decision‐making documentation regarding treatment goals and outcome preferences .…”

“…The form’s content arose from reviews of forms at multiple Australian hospitals . We felt that NFCPR documentation should be separate from decision‐making documentation regarding treatment goals and outcome preferences . The GOC page aimed to be broad in scope and address the medically indicated treatment (and likely outcome), patient existential issues and patient outcome preferences.…”

“…A GOC discussion between the patient and doctor (sometimes including significant others) should evaluate the realistic options for treatment and likely main outcomes in the context of the patient’s values . The purpose of a form is to stimulate such a discussion, guide its content and document the outcomes.…”