Background CPR decisions are a significant part of advanced care planning. Clear communication with patients and those important to them, and documentation of decision making, is essential for good care and, following court cases, is now also a legal requirement.
Purpose The audit aim was to assess documentation of CPR decisions and communication on admission to Marie Curie Hospice Bradford and review CPR documentation on the patient‘s electronic palliative care co-ordination system (EPaCCS).
Methods Standards were set using Resuscitation Council (UK)and GMC guidance and the hospice’s CPR policy. All admissions between 1 st-31st January 2017 were audited and results compared to an initial audit in 2016. The 2017 audit was extended to assess CPR decision making documentation on EPaCCS.
Results 38 admissions were audited. All had a CPR decision documented of which 32 were DNACPR. 22 were discussed with patients, 9 with relatives and 8 were not discussed. In 2016 of 37 admissions audited, all had a CPR decision. Only 13 DNACPR decisions were discussed with patients.
On EPaCCS, of the 10 DNACPR decisions not discussed at admission, 6 were discussed previously with patients and 2 were not discussed.
Conclusions and recommendations In both audits 2 audit standards were met:
All patients should have a decision about CPR at the time of admission.
CPR decisions and rationale should be clearly documented.
2 standards were not met:
CPR should be discussed with all patients.
CPR should be discussed with relatives/those important to the patient.
As the hospice moves to electronic patient records documentation will be modified. In addition to general advanced care plans, 3 specific sections are to be completed for CPR decision, discussion with patient and discussion with relatives. The aim is to improve documentation of discussions and continuity with EPaCCS. A re-audit will be completed.
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