Outcomes of oesophageal stenting for palliation in elderly patients with oesophageal malignancy

Abstract

Background.– There is no legislation in Ireland regarding do not attempt resuscitation(DNAR) orders. The British Geriatric Society(BGS) has guidelines that can direct physicians. Our aim was to look at our institution’s policy, how it correlates to the BGS guidelines and our adherence to it. Methodology.– The policy of our institution was reviewed. Documentation of DNAR orders in a 100-bed nursing unit was reviewed over a 24hour period. Results.– Our policy adheres to the BGS guidelines. Sixty-four percent (n=64) of residentswere female.Median agewas 84 (SD 6.64). Dementia was documented present in 70% (n=70). Admissions were from hospital (77%), another long stay institution (19%) and home (4%). Median length of stay(LOS) was 437 days. 82% (n=82) had DNAR orders with 92.68% (n=74) documented in their medical note. 7.32% (n=6) were reported to have DNAR decisions but documentation was not found due to inaccesible notes. Of the 76 documented, two were in closed files. Of those remaining documentationof capacity, reason forDNARanddocumenteddiscussion with family were present in 21.62% (n=16), 44.59% (n=33), 50.7% (n=39) respectively. It was most commonly discussed with the patient’s offspring(43.59%, n=17). It was documented discussed with 9.91% (n=5) of patients. No significant difference in resuscitation status with regard to LOS (P=0.68), gender (P=0.778), or residence before admission (P=0.906)was seen. DNARorderswere significantly associated with older age(84 vrs 79, P=0.048) and documented dementia (74.39% vrs 50%, P=0.04). Conclusions.– Our adherence to documentation of DNAR orders is suboptimal. Poor documentation does not indicate a lack of appropriate decisions. We aim to achieve 100% compliance through education and introduction of a DNAR proforma.