OP24 Usage of do-not-attempt-to resuscitate-orders in a swedish community hospital – patient involvement, documentation and compliance

Abstract

Background The purpose of the study was to characterize patients dying in a community hospital with or without attempting cardiopulmonary resuscitation (CPR) and to describe patient involvement in, documentation of, and compliance with decisions on resuscitation (Do not attempt to resuscitate orders; DNAR). Material and methods All patients who died in Kalmar County Hospital during January 1, 2016 until December 31, 2016 were included. All information from the patients’ electronic chart was analyzed. Approved by the Regional Ethic review Board in Linkoping, Sweden. Results Of 660 patients (mean age 77.7 ± 12.1 years; range 21–101; median 79; 321 (48.6%) female), a DNAR order had been documented in 563 patients (85.3%). In 66 of 94 (70.2%) patients without DNAR, CPR was unsuccessfully attempted. 28 of 94 (29.8%) patients died without attempt at CPR and without a DNAR order in place. In 4 of 563 (0.7%) patients CPR was attempted despite a DNAR order in place. In 416 patients (73.9%) the DNAR order had not been discussed with neither patient nor family/friends. Moreover, in 84 cases (14.9%) neither patient nor family/friends were even informed about the decision on code status. Conclusions In general, a large percentage of patients in our study had a DNAR order in place (85.3%). However, 28 patients (4.2%) died without CPR attempt or DNAR order and DNAR orders had not been discussed with the patient/surrogate in almost three fourths of the patients. Further work has to be done to implement ethical CPR guidelines to insure patient autonomy.