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Do not attempt cardiopulmonary resuscitation (DNACPR) decisions for older medical inpatients: a cohort study
  1. Jane Walker1,
  2. Katy Burke2,
  3. Marta Wanat3,
  4. Harriet Hobbs1,
  5. Isabelle Rocroi1 and
  6. Michael Sharpe1
  1. 1 Psychological Medicine Research, University of Oxford Department of Psychiatry, Oxford, UK
  2. 2 University College London Hospitals NHS Foundation Trust Palliative Care Team, London, UK
  3. 3 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Dr Jane Walker, Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK; jane.walker{at}psych.ox.ac.uk

Abstract

Objectives A decision not to attempt cardiopulmonary resuscitation in the event of cardiorespiratory arrest requires a discussion between the doctor and the patient and/or their relatives. We aimed to determine how many older patients admitted to acute medical wards had a pre-existing 'do not attempt cardiopulmonary resuscitation' (DNACPR) decision, how many had one recorded on the ward and how many of those who died had a DNACPR decision in place.

Methods A prospective cohort study, using data from medical records, of 481 consecutive patients aged ≥65 years admitted to the six acute medical wards of the John Radcliffe Hospital, Oxford.

Results 105/481 (22%) had a DNACPR decision at ward admission, 30 of which had been made in the emergency unit. A further 45 decisions were recorded on the ward, mostly after discussion with relatives. Of the 37 patients who died, 36 had a DNACPR decision. For the 20 deceased patients whose DNACPR decision was recorded during their admission, the median time from documentation to death was 4 days with 7/20 (35%) recorded the day before death.

Conclusions Older patients with multimorbidity need the opportunity to discuss the role of CPR earlier in their care and preferably before acute hospital admission.

  • chronic conditions
  • clinical decisions
  • communication
  • hospital care

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Footnotes

  • Contributors JW, KB and MS designed the study. MW and KB collected data. KB, JW and HH analysed data. JW drafted the manuscript. All authors contributed to revision of the manuscript.

  • Funding This study was funded by the UK National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care at Oxford Health NHS Foundation Trust, Oxford, UK.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. The funders had no involvement in study design; collection, analysis and interpretation of data; writing of the report; or in the decision to submit the article for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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