95 Do Not Attempt Resuscitation: all or nothing?

Abstract

Abstract Background Do Not Attempt Resuscitation (DNAR) orders may be implemented when patients do not wish to receive Cardio-Pulmonary Resuscitation (CPR) or when CPR is deemed non-beneficial. Complex ethical and medical considerations influence these decisions, emphasising the need for accurate documentation as per national policies. Our aim was to assess comprehensive documentation of DNAR decisions and healthcare providers’ opinions on managing patients with DNAR orders. Methods We conducted a point-prevalence chart review of adult inpatients with a DNAR order on March 2nd, 2023.We surveyed healthcare providers using a structured tool and analysed the data using Excel. Results We identified 22 (n = 22) charts for review. All charts had a DNAR form, but only 31.8% (7) had documented discussion details. 54.5% (12) lacked a discussion with the patient regarding the DNAR decision, and 58.3% (7) lacked documentation explaining the reasoning. 72.7% (16) lacked clear documentation on the reasoning for the DNAR status decision. Regarding healthcare providers’ opinions on patients with DNAR status, we received 46 completed questionnaires (n = 46). Most respondents believed simple bedside investigations and non-invasive interventions were appropriate for DNAR patients. However, there was a discrepancy in opinion regarding more invasive interventions, such as Naso-Gastric Tube placement (52%) or inotropic support (48%). 84.8% (39) of staff believe there is a distinction between palliative patients and those designated as DNAR. 80.4% (37) of nursing staff reported hesitancy in discussing DNAR status with doctors when patients deteriorate. 58.7% (27) of staff believed their approach to care changes when a patient is labelled DNAR. Conclusion Our audit demonstrates the need for improved DNAR status documentation. Current practices do not meet national guidelines, creating ambiguity and subsequent confusion during emergencies. This may be exacerbated by disparities in hospital staff opinion regarding DNAR patients, highlighting the importance of establishing local policies to improve staff education and patient care.