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Pre-printed ‘Do Not Attempt Resuscitation’ forms improve documentation?

2003; Elsevier BV; Volume: 59; Issue: 1 Linguagem: Inglês

10.1016/s0300-9572(03)00176-x

1873-1570

Nick Castle, Robert Owen, Gary Kenward, N Ineson,

Family and Patient Care in Intensive Care Units

Do not-attempt-resuscitate orders are fundamental for allowing patients to die peacefully without inappropriate resuscitation attempts. Once the decision has been made it is imperative to record this information accurately. However, during a related research projected we noted that documentation was poor and we thought that the introduction of a pre-printed Do Not Attempt Resuscitation (DNAR) form would improve the documentation process.Two sets of identical research questions were applied retrospectively, 12-months apart, to notes of adult patients (>18 years) who had died during a hospital admission without under-going a resuscitation attempt. Between the first and the second audit, a new resuscitation policy that incorporated a pre-printed DNAR form was introduced into our hospital.A pre-printed DNAR form improved documentation when measured against; clarity of DNAR order (P=0.05), date decision was made/implementation (P=0.014), presence of clinician's signature (P=0.001), identification of the senior clinician making the decision (P< or =0.001) and justification for the DNAR decision (P< or =0.001). However, the pre-printed form made little improvement in encouraging patient involvement in the DNAR decision-making process (P=0.348).A pre-printed DNAR form can improve documentation significantly but it has little effect in encouraging patient involvement in the decision-making process.