Do Not Attempt Resuscitation (DNAR) Status Awareness Among Healthcare Staff For Patient's Under Their Care: A Clinical Audit

Abstract

Listen

Translate article

Abstract Background The HSE National Consent policy recommends service providers should develop specific mechanisms for the documentation and dissemination of decisions relating to resuscitation. The local hospital guidelines state DNAR orders should be clearly documented in the patient’s records and communicated to relevant staff at nursing handover and clinical rounds. This audit aims to ensure DNAR status is known or easily accessible by healthcare staff if a cardiac arrest occurs. The population age of the wards audited are predominantly >80 years. Methods A questionnaire was distributed to all nursing and medical staff working on the designated wards over a two-week period via SurveyMonkey QRcode (33 responses). The questionnaire contained five multiple choice questions with rating scale responses. Charts containing DNAR forms were reviewed alongside corresponding nursing handover sheet during this period (27 charts). Results 6% of healthcare staff were very confident of DNAR status of patients under their care at the time of survey without accessing medical notes/handover sheet, increasing to 24% with access. 18% reported DNAR status is very easily found in both the medical chart and nursing notes. 82% report the coloured DNAR form (used 56% of the time) is much easier to locate than the photocopy. 89% of forms were attached to the front of medical charts, 7% attached to admission note and 4% unfiled. 33% of patients with signed DNAR forms did not have DNAR status recorded on the nursing handover sheet. Conclusion The confidence among healthcare staff regarding DNAR status of patients under their care is low. This audit highlights that an explicit and reproducible system to relay DNAR information between healthcare staff is not in place. Recommendations for this clinical site include; only keeping original coloured DNAR forms on the ward, ensuring completed forms are at the front of patient charts and creating a DNAR status column on medical and nursing handover sheets.