Cardiopulmonary resuscitation: capacity, discussion and documentation.

BACKGROUND: End-of-life care decisions, including treatment such as cardiopulmonary resuscitation (CPR), are complex issues requiring a patient to have the capacity for effective decision-making. AIM: To assess the prevalence and documentation of CPR decisions in our hospital in patients aged > 65 years.
DESIGN: Prospective audit.
METHODS: Review of patient notes and resuscitation forms within our acute Trust on Elderly Care and General Medicine wards, including the decisions made, involvement of patient and/or family members and whether an assessment of capacity was made.
RESULTS: On the Elderly Care wards, 37 CPR decisions were made on 104 patients, and nearly all of these were clearly documented. On the General Medical wards, only one decision out of 40 patients was made. Geriatricians incorporated patient views in one quarter of decisions; all but one of these patients wanted CPR. Of those patients 'not for CPR', family members were informed in only one third of cases, according to the documentation. Capacity was documented on only four occasions. DISCUSSION: Geriatricians make significantly more CPR decisions than general physicians do, but still involve patient and family views in only a minority of cases, and an assessment of capacity is rarely explicitly documented. We suggest a three-step approach to clinical decision making, to increase both the volume and the quality of CPR decisions, which may be improved further by the use of information leaflets for patients and their families.