Background In response to the guidelines issued by the Resuscitation Council relating to making decisions about cardiopulmonary resuscitation (CPR), the National Council for Hospice and Specialist Palliative Care Services and the Association for Palliative Medicine of Great Britain and Ireland produced joint guidance for palliative care. This included the recommendation that written information be made available to patients about the hospice CPR policy, how decisions are made about CPR and the facilities available at the unit.
Aims To identify whether all patients had received the hospice CPR information policy and whether the resuscitation component of the admission clerking had been fully completed. To identify how many CPR decisions are being discussed with the patient and in those situations where it is the clinician making the decision, whether reasons are documented in the medical notes explaining this decision.
Methods The medical notes of all inpatients at Birmingham St Mary's Hospice were analysed prospectively over a 2 week period, when bed occupancy was greater than 60 per cent.
Results All patients received a patient information booklet regarding the hospice resuscitation policy and there was high compliance (94%) of accurate documentation around CPR decisions. However, 82% of these decisions had been made by the clinician without discussion with the patient and only two patients (12%) had actually clearly had a discussion with the admitting doctor and had chosen themselves not be for resuscitation.
Conclusion If a patient is in the terminal phase of their illness, CPR is likely to be futile and the patient has no realistic choice to make. However, this audit highlighted the need for more discussions with patients around their CPR status and documentation of this in the medical notes, even if this is to make patients aware that decisions are being made on their behalf and invite discussions if desired.
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