Authors (including presenting author) :
Lam PT (1), Cheng Gladys (2), Ko PS (3), Cheung KK (3)
Affiliation :
(1) KEC Clinical Ethics Committee (2) UCH Quality and Safety Office (3) Department of Medicine & Geriatrics
Introduction :
The HA Guidelines on DNACPR was recently revised involving changes in the level of competency of doctors making DNACPR decision, and allowance of contingency measure for exceptional urgent situations in making DNACPR order. This revised guideline was promulgated among all public hospitals with a universal “DNACPR form for hospitalized patients”, and it is recommended that the hospital should have in place an audit system. United Christian Hospital was one of the first to carry out an internal audit.
Objectives :
To assess the level of compliance and completion of the “DNACPR form for hospitalized patients” in relation to the guideline.
Methodology :
With preceding estimation of sample size to be 131, 137 medical records containing “DNACPR form for hospitalized patients” were conveniently selected from all deceased records during 1 Apr – 31 May 2017. Using self-designed audit form, retrospective evaluation of the DNACPR form and clinical notes documentation were both performed by the auditors.
Result & Outcome :
Among the 137 medical records, 115 (83.9%) were from M&G Dept, 18 (13.1%) were from Surgical Dept, while the rest (3%) were from ICU and Ortho Dept. There was no death case from Paediatric Dept during the audit period. Overall, there was no CPR performed after the DNACPR order was made. The old version of the form was used in 8 (5.8%). Affixture of gum label with HK ID no., Section I (Diagnosis), Section II (Current condition), Section IV (Decision on DNACPR) were satisfactory completed over 90%. For Section III (Communication on DNACPR, or previous decision on DNACPR), it was found that only 12 (8.8%) had the name of relatives written down. For patients having a valid “DNACPR Form for non-hospitalized patient”, only 1 out of 6 (16.7%) had the copy of the form attached. For Section V (Signatures of healthcare team doctors), department and hospital was only filled in 65%. Among the 15 orders (10.9%) which required phone endorsement by specialist doctor, 1 was not finally signed and 3 were signed after 48 hours. For Section VI (Review), among the 23 orders (16.8%) which required review of DNACPR order by doctor, 11 orders had never been reviewed, and for those reviewed, 1 was reviewed after the recommended period of 14 days. For Section VII (In-patient DNACPR order in exceptional urgent period), among the 3 orders (2.2%) which were made by higher specialist trainees, 1 failed to fill in the diagnosis of the terminal / end stage illness. Conclusion: No CPR was attempted in all patients with a DNACPR order. Around 11 % required phone endorsement by specialist doctor, and most were timely signed by specialist. Only 2.2% DNACPR order were signed by assigned higher specialist trainees. Except a few items, overall most of the sections of the “DNACPR form for hospitalized patients” were satisfactory completed and documented in line with the Guidelines.
Co-location with:
