M Schluep1, S E Hoeks2, H Endeman3, S IJmkers4, T M M Romijn5, J Alsma6, F H Bosch7, A D Cornet8, A H M Knook9, A W M M Koopman-van Gemert10, T van Melsen11, R Peters12, K S Simons13, E J Wils14, R J Stolker2, M van Dijk6. 1. Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: m.schluep@erasmusmc.nl. 2. Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands. 3. Department of Intensive Care Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands. 4. Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Anaesthesiology, Ikazia Hospital, Rotterdam, the Netherlands. 5. Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Anaesthesiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands. 6. Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands. 7. Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem, the Netherlands. 8. Department of Intensive Care Medicine, Medisch Spectrum Twente, Enschede, the Netherlands. 9. Department of Intensive Care Medicine, Reinier de Graaf gasthuis, Delft, the Netherlands. 10. Department of Anaesthesiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands. 11. Department of Intensive Care Medicine, Haaglanden Medical Centre, The Hague, the Netherlands. 12. Department of Cardiology, Tergooi Hospital, Hilversum, the Netherlands. 13. Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands. 14. Department of Intensive Care Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
Abstract
BACKGROUND: The decision to attempt or refrain from resuscitation is preferably based on prognostic factors for outcome and subsequently communicated with patients. Both patients and physicians consider good communication important, however little is known about patient involvement in and understanding of cardiopulmonary resuscitation (CPR) directives. AIM: To determine the prevalence of Do Not Resuscitate (DNR)-orders, to describe recollection of CPR-directive conversations and factors associated with patient recollection and understanding. METHODS: This was a two-week nationwide multicentre cross-sectional observational study using a study-specific survey. The study population consisted of patients admitted to non-monitored wards in 13 hospitals. Data were collected from the electronic medical record (EMR) concerning CPR-directive, comorbidity and at-home medication. Patients reported their perception and expectations about CPR-counselling through a questionnaire. RESULTS: A total of 1136 patients completed the questionnaire. Patients' CPR-directives were documented in the EMR as follows: 63.7% full code, 27.5% DNR and in 8.8% no directive was documented. DNR was most often documented for patients >80 years (66.4%) and in patients using >10 medications (45.3%). Overall, 55.8% of patients recalled having had a conversation about their CPR-directive and 48.1% patients reported the same CPR-directive as the EMR. Most patients had a good experience with the CPR-directive conversation in general (66.1%), as well as its timing (84%) and location (94%) specifically. CONCLUSIONS: The average DNR-prevalence is 27.5%. Correct understanding of their CPR-directive is lowest in patients aged ≥80 years and multimorbid patients. CPR-directive counselling should focus more on patient involvement and their correct understanding.
BACKGROUND: The decision to attempt or refrain from resuscitation is preferably based on prognostic factors for outcome and subsequently communicated with patients. Both patients and physicians consider good communication important, however little is known about patient involvement in and understanding of cardiopulmonary resuscitation (CPR) directives. AIM: To determine the prevalence of Do Not Resuscitate (DNR)-orders, to describe recollection of CPR-directive conversations and factors associated with patient recollection and understanding. METHODS: This was a two-week nationwide multicentre cross-sectional observational study using a study-specific survey. The study population consisted of patients admitted to non-monitored wards in 13 hospitals. Data were collected from the electronic medical record (EMR) concerning CPR-directive, comorbidity and at-home medication. Patients reported their perception and expectations about CPR-counselling through a questionnaire. RESULTS: A total of 1136 patients completed the questionnaire. Patients' CPR-directives were documented in the EMR as follows: 63.7% full code, 27.5% DNR and in 8.8% no directive was documented. DNR was most often documented for patients >80 years (66.4%) and in patients using >10 medications (45.3%). Overall, 55.8% of patients recalled having had a conversation about their CPR-directive and 48.1% patients reported the same CPR-directive as the EMR. Most patients had a good experience with the CPR-directive conversation in general (66.1%), as well as its timing (84%) and location (94%) specifically. CONCLUSIONS: The average DNR-prevalence is 27.5%. Correct understanding of their CPR-directive is lowest in patients aged ≥80 years and multimorbid patients. CPR-directive counselling should focus more on patient involvement and their correct understanding.
Authors: Eva Piscator; Therese Djärv; Katarina Rakovic; Emil Boström; Sune Forsberg; Martin J Holzmann; Johan Herlitz; Katarina Göransson Journal: Resusc Plus Date: 2021-04-29