P-66 An audit of DNACPR decisions and discussions during the COVID-19 pandemic

Abstract

<h3>Background</h3> Do not attempt cardiopulmonary resuscitation (DNACPR) discussions and decisions are an important part of person-centred care. Compassionate discussion with patients is a legal requirement when clinicians are introducing DNACPR forms. A recent Care Quality Commission report emphasised that all decisions should be individualised and part of broader advance care planning (Care Quality Commission, 2021). <h3>Aim</h3> The aims of this audit were to evaluate the timing of DNACPR discussions, to explore whether conversations regarding DNACPR were documented and whether DNACPR discussions were part of wider advance care planning. The standards for the audit were based on national Resuscitation Council guidance (2021), ‘Deciding Right’ regional document (Northern Cancer Alliance, 2015) alongside the Trust policy on resuscitation. <h3>Methods</h3> All patients with DNACPR forms initiated during an inpatient stay in November 2020 were identified from the Trust’s database. A data collection tool was created to retrospectively collate information from the patient’s electronic records. <h3>Results</h3> We identified 62 patients who had a DNACPR initiated in November 2020. The results were overall very positive; a discussion with the patient, or where necessary with a relative, took place in all patients where electronic notes were accessible. Six (10%) DNACPR forms were initiated at the time of deterioration and 39 (63%) were as part of a conversation incorporating elements of advance care planning, with more thorough advance care planning conversations occurring in six patients (10%). Almost 30% of patients audited were positive for COVID-19 infection. Where CPR was felt to be of no clinical benefit, COVID-19 infection was rarely (2% of patients) the named medical condition documented in the DNACPR. <h3>Conclusions</h3> Documentation regarding the timing of DNACPR decisions and DNACPR discussions was of a high standard, despite increased pressures during the COVID-19 pandemic. Advance care planning discussions occurred, however, further analysis would be necessary to fully evaluate the quality of these discussions.