Background In 2014 the Tracey judgement resulted in amended Resuscitation Council guidance, recommending that patients and relatives should be involved in resuscitation discussions unless it would cause harm. This project aimed to examine whether improved hospice resuscitation discussion documentation between 2013 and 2015 found regionally by the West Midlands palliative trainee collaborative (WM CARES) was evident in hospice and hospital settings across the United Kingdom.
Methods National resuscitation standards in 2013 and 2015 from the UK Resuscitation Council were identified. Data collectors were recruited by the UK Palliative trainee Research Collaborative (UK PRC). Do not attempt resuscitation decision (DNACPR) documentation was sought for 30 deaths in 2013 and 30 deaths in 2015 from each participating hospice and hospital. An excel database was used for data collection and analysis.
Results Data for 805 patients across 17 sites (5 hospitals and 12 hospices) in England and Wales were collected. 2013 data were missing from one site and 130 patients were excluded as did not meet audit criteria. 40% (157) of patients had documented resuscitation discussions in 2013 compared to 60% (271) in 2015. More documented DNACPR discussions occurred with patients in hospices (57%, 330) compared with patients in hospital (42%, 98). However, relatives in hospital settings (73%, 168) were more likely to be documented as involved in discussions compared with relatives in hospice settings (58%, 334). The most common reasons cited for not discussing DNACPR with patients (2013 and 2015) were: lack of capacity or advanced illness. 20% (171) did not document a reason for no resuscitation discussion, but this was 75% less (120 to 30) in 2015 compared with 2013.
Conclusions DNACPR discussions appear to be happening more frequently in 2015, compared with 2013, but there is clearly room for improvement in hospices and hospitals.
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