Abstract
Background: t Recent Court of Appeals rulings found failure to discuss DNACPR decision breached Article 8 of the European Human Rights Act. Patients and families should be involved in decision making process. (Tracey 2014). These decisions should be communicated to primary care.
Aims: To assess practice of discussions of DNACPR decisions with patients & family; consultant review of decisions & communication with primary care.
Method: Retrospective review of COPD admission notes in North Bristol Trust between 1st February – 30th April 2014 (N=91). Existing community DNACPR were excluded (N=2)
Results: 23.5% had hospital DNACPR forms completed. There were 4 deaths. 86% were completed by a junior doctor. Consultants reviewed 83% of decisions, 61% <24 hours. 71.4% patients were involved in decisions. 4% had no reason why not discussed.
| Reason for DNACPR | Details |
| Resuscitation would not be successful n=12 | 9 (75%) discussed 3 (25%) NOT discussed Reasons for not discussing: • “confused from respiratory failure” (n= 1) • “Patient very unwell” (n=1) • no reason stated (n=1) |
| May be successful but followed by unacceptable quality of life n=3 | 1 (33%) discussed. 2 (33%) NOT discussed Reasons for not discussing • “patient too unwell” (n=2) |
| Wishes of patient n=6 | 6 (100%) discussed |
100% not discussed with patient were discussed with family. No DNACPR decision was recorded on discharge summary.
Discussion: There was good compliance with legal duty to discuss with patient. The majority not discussed were due to patient being too unwell.
There is a disparity, however, when communicating with primary care, with none communicated on discharge summary. Discharge summary template has been adjusted to improve this.
- Copyright ©the authors 2016
