Do Not Resuscitate? The impact of standardised resuscitation documentation on the approach to hospital care in older patients
Date
2022
Authors
Dignam, Colette Michelle
Editors
Advisors
Thompson, Campbell H
Journal Title
Journal ISSN
Volume Title
Type:
Thesis
Citation
Statement of Responsibility
Conference Name
Abstract
When hospital clinicians care for older, chronically unwell and dying patients, one part of their role is recognising the limitations of curative medicine. If these limitations are not considered pre-emptively, medical teams risk providing cardiopulmonary resuscitation (CPR) and other invasive treatments to patients who may not benefit, or, had they been given the choice in advance, would not have wanted the treatment on offer. The need for pre-emptive treatment decisions has led to the use of 'Not for Cardiopulmonary Resuscitation' (No-CPR) orders, which in more recent times, have been replaced by standardised resuscitation plans or goals of care plans. In South Australia, the pre-existing ad-hoc approach to No-CPR orders and resuscitation documentation was completely overhauled in July 2014 with the introduction of the "Resuscitation Planning-7 Step Pathway Clinical Directive" (the Directive). The directive outlines a patient-centred and best-practice approach for planning care, including resuscitation. This approach centres on the use of a new standardised process to resuscitation planning known as the '7-Step Pathway'. Treatment recommendations are subsequently documented on the 'Resuscitation Alert- Resuscitation Plan - 7 Step Pathway Form [MR RESUS]' (7-Step Form). The primary aim of this thesis was to provide a before-after comparative analysis of how the introduction of the Directive and associated roll-out of the 7-Step Form has affected hospital practice in patients aged 70 years and over and nearing end of life. Areas of interest were changes to the frequency and clarity of documentation, changes in the use of terminology in resuscitation documentation, and changes in the composite use of potentially burdensome treatments such as CPR, mechanical ventilation and Intensive Care Unit admission. Through reviewing different aspects of the 7-Step Form's function and bedside impact, the extent to which the Directive has addressed existing deficits in the delivery of safe and high-quality care for hospital inpatients is established. This research has demonstrated that the implementation of the Directive, embodied in the 7- Step Pathway process and 7-Step Form, is associated with increased frequency of resuscitation planning discussions and subsequent documentation. There is, however, continued evidence of ambiguous terminology in documentation, and no significant change in the use of Intensive treatments at end of life. While an imperfect intervention, the 7-Step Form represents a significant and progressive leap forward from the multitude of ad-hoc and inconsistently recorded 'No-CPR' orders that it replaced.
School/Discipline
Adelaide Medical School
Dissertation Note
Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2022
Provenance
This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at: http://www.adelaide.edu.au/legals