Abstract
ObjectivesA 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.MethodsA 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.Results105/481 (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.ConclusionsOlder patients with multimorbidity need the opportunity to discuss the role of CPR earlier in their care and preferably before acute hospital admission.
Funder
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care at Oxford Health NHS Foundation Trust, Oxford, UK
Subject
Medical–Surgical Nursing,Oncology (nursing),General Medicine,Medicine (miscellaneous)
Reference17 articles.
1. British Medical Association, Resuscitation Council (UK), Royal College of Nursing . Decisions relating to cardiopulmonary resuscitation. 3rd edn. London: Resuscitation Council, 2016.
2. CQC . Protect, respect, connect – decisions about living and dying well during COVID-19, 2021. https://www.cqc.org.uk/publications/themed-work/protect-respect-connect-%E2%80%93-decisions-about-living-dying-well-during-covid-19
3. Predicting mortality of elderly patients acutely admitted to the Department of Internal Medicine
4. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study
5. The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review