Background DNACPR decisions are an important but small part of decision making and advance care planning at end of life. Historically, patients and families have not always been involved in these decisions, as they relate to a medical intervention which is often unlikely to benefit patients. Clinical practice of DNACPR decision making may have changed in light of court judgements in the cases of Tracey and Winspear, and updated guidelines from governing bodies and the resuscitation council. A review of historical audits of documentation of DNACPR decision making within the hospice inpatient unit took place to review changes over time.
Methods Annual audit was undertaken over a five year period using standards taken from local and national guidelines. This was then compared and contrasted to review the impact over time.
Results The percentage of patients in the hospice inpatient setting with a decision about resuscitation recorded has remained steady. There has been a gradual increase in the proportion of patients who have a clear rationale recorded for DNACPR. In a significant number of patients, the rationale for the DNACPR decision being made was patient choice.
There has been an increase in the proportion of patients involved in decision making about resuscitation from 35% in 2013 to 100% of those with capacity in 2016 and 2017. There has also been an increase in the proportion of relatives involved in decision making, particularly where the patient lacks capacity.
Conclusions Changes to the legal framework and guidance around DNACPR have increased the number of patients and families involved in DNACPR decision making. It is unclear from this data what patients and their families thought about their involvement, and whether this was perceived to be beneficial. Further research in this area is encouraged.
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