Example 1: An audit of a ‘do not resuscitate’ policy in an acute trust
S Blayney, A Swan, J Ashworth Jones, M Diwan and D King.
Department of Medicine for the Elderly, Wirral University Teaching Hospital, UK
The natural reaction when any doctor or nurse sees a collapsed patient is to resuscitate them using cardiac massage and mouth-to-mouth resuscitation when necessary. However, for patients with terminal conditions this is not always appropriate and may be distressing for everyone concerned. In acute hospitals settings, some patients' case notes may therefore be labelled with ‘DNR’ or ‘do not resuscitate’. This process can be fraught with difficulty: who makes the decision? What happens when the patient's condition changes? How much is discussed with the patient and their relatives? In the UK, national guidelines are available to guide this process. This audit set out to see whether the hospital was following the guidelines appropriately.
This audit was performed in a district general hospital in the north of England. It was started in 2001 and annual data were then collected every few years.
Step 1: Problem identification
Healthcare staff need to be able to correctly assess the need for a ‘DNR’ decision to be made and know how to go about this process. Patients and relatives should be included in the decision making, even though this is often a difficult subject to broach.