Implementation of cardiopulmonary resuscitation guidelines in elderly care departments across: a survey of 13 hospitals shows wide variability in practice.

OBJECTIVE: The United Kingdom Department of Health advises hospitals that they should implement a policy relating to cardiopulmonary resuscitation (CPR) that takes account of published guidelines relating to decision making for resuscitation. We wished to see if these guidelines were leading to implementation of a similar policy in different Elderly Care (EC) departments. SETTING: The acute and rehabilitation wards in 13 hospitals from the South Thames West region. DESIGN: On one day the notes of all in-patients, over 55 years, under the care of an EC physician were reviewed. RESULTS: A CPR decision had been made in 465 (47%) of the 990 in-patients, 379 Do Not Attempt Resuscitation (DNAR) orders were made. The percentage of patients in whom a CPR decision had been made varied from 15 to 97% between departments. CONCLUSIONS: Implementation of the guidelines for decision making for resuscitation varies greatly across this region of the United Kingdom.

The influence of new guidelines on cardiopulmonary resuscitation (CPR) decisions. Five cycles of audit of a clerk proforma which included a resuscitation decision.

Current guidelines advise discussion with patients before issuing a 'do not attempt resuscitation' (DNAR) order. We report five audit cycles of cardiopulmonary resuscitation (CPR) documentation after introducing a proforma, the last cycle following the latest guidelines. In first audit data were collected from 75 patient discharges. CPR decisions were documented in 27 (36%). Four subsequent point prevalence audits carried out on all inpatients following proforma introduction showed documentation improved to 102/109 (94%), 135/148 (91%), 131/140 (94%) and 102/119 (86%) in cycles two, three, four and five, respectively. The last three audits also revealed that consultants consistently made more DNAR orders than trainee doctors. However, following the introduction of the latest guidelines the proportion of patients in whom a decision was made, and the percentage of those decisions that were DNAR, fell.