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An audit of do not attempt cardiopulmonary resuscitation orders in a District General Hospital
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Poster Presentations / Resuscitation 84S (2013) S8–S98
Materials and methods: 46 GPs were participated in our research. All GP’s were asked to perform BLS in two simulated situation: an adult patient with cardiac arrest (resuscitation task) and another adult, unconscious patient (airway task). For data collection a standardized BLS skill assessment sheet was used. For statistical analyses SPSS 15 software was used (Student’s t test, Chi-square). Results: The maximum score was 25 points. The highest score achieved was 16 points, and the lowest is 0 point. Those general practitioners, who have already been performed CPR alone, had averaged 4.5 points in the CPR task, while those who have never had this opportunity, only 2.6 points (p = 0.043). The years spent as a general practitioner negatively influenced the outcome of each task (p = 0.013; p = 0.044). Conclusions: These general practitioners did not meet the minimum requirements that even lay rescuers can expect from a life-saving situation. Those GPs who have been performed CPR on BLS level, performed better. Keywords: BLS; General practitioner; Emergency medicine; Resuscitation.
prompt communication of DNACPR status to the GP, as will the medical clerking proforma to help document consideration of resuscitation on admission. References 1. General Medical Council. Treatment and care towards the end of life: good practice in decision making. London: GMC; 2010. 2. British Medical Association, Resuscitation Council (UK), Royal College of Nursing. Decisions relating to cardiopulmonary resuscitation: a joint statement. London: BMA; 2007.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.184 Mechanical Devices AP159 Mechanical chest compressions and outcome in patients with out-of-hospital cardiac arrest: A registry study Isabella Holm ∗ , Hans Olson, Hans Friberg
http://dx.doi.org/10.1016/j.resuscitation.2013.08.183 AP158 An audit of do not attempt cardiopulmonary resuscitation orders in a District General Hospital Ruth Thomas 1,∗ , Matthew Hough 2 , Lydia Richardson 2 , Charles Warren 2 1
Royal Bournemouth Hospital, Bournemouth, Dorset, UK 2 Dorset County Hospital, Dorchester, Dorset, UK Background: Cardiopulmonary resuscitation (CPR) has the great benefit of potentially prolonging a patient’s life, but the burdens of CPR include trauma, lack of dignity in dying, permanent neurological disability and significant worsening of their chronic medical condition. Due to this there have been recent publications from the General Medical Council (GMC)1 and British Medical Association (BMA)2 on Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions; when they should be made and how they should be documented. Aims: To assess how many patients in Dorset County Hospital had a documented resuscitation discussion and decisions on admission. Those patients with DNACPR decisions were further evaluated to assess documentation against current standards. Method: A 2-part questionnaire was used to audit all adult surgical and medical inpatients over one week in April 2011. Once patients were discharged, notes were reaudited with part 2. Various measures were taken to improve on the results prior to the audit being repeated in October 2012. Results (results for the second audit are in brackets): 249 (233) patients were audited with 39 (61) DNACPR orders in place. 10.8% (20.2%) had resuscitation considered within 24 h of admission. Of the DNACPR patients 100% (98.3%) had a reason documented; 61.5% (83.6%) patients were discharged. In 23% (26%) a consultant did not ratify the decision during the admission. Of those patients that survived to discharge, 95.8% (100%) of DNACPR decisions were still in place but only 4.3% (18.8%) were communicated to the General Practitioner (GP). Conclusions: The results of both audits are again being presented to raise awareness within the hospital and tackle the areas that perform badly (documentation, communication). The Electronic Discharge Summary system will hopefully be amended to
Skåne University Hospital, Lund University, Lund, Sweden Purpose of the study: To investigate the prevalence of reporting and registration of out-of-hospital cardiac arrest (OHCA) patients to a national cardiac arrest registry by the ambulance staff in a region of Sweden during two years (2010–2011). We also investigated the use of a mechanical chest compression device and compared survival rates. Materials and methods: All ambulance records were retrospectively surveyed during the two-year period by examining a regional electronic medical record system (ISPASS) for 2010 and by manually scrutinizing all paper ambulance records for 2011. Patients enrolled in the national cardiac arrest registry were divided into two groups, depending on whether they had received mechanical chest compressions or not. Results: A total of 1348 OHCA patients were identified in the region during the study period, 693 (51%) were reported by the ambulance staff and 655 (49%) were identified and registered retrospectively. Among all OHCA patients, 61.1% received mechanical chest compressions in the region, as compared to 24.7% in the country, but the one-month survival rates were similar; 10.2% versus 10.3%. Survival rates were significantly lower in patients receiving mechanical compressions, 6.5% as compared to 11.1%. Several patient characteristics differed between the groups. Notably, time from alarming the ambulance until defibrillation was significantly longer in patients receiving mechanical CPR (p < 0.05). Conclusions: Only half of all OHCA patients was reported by the ambulance staff in the region, the other half was identified retrospectively. The use of mechanical chest compressions differed significantly between regions, but the overall survival rates were similar. The use of mechanical chest compressions may delay time to defibrillation. http://dx.doi.org/10.1016/j.resuscitation.2013.08.185
Poster Presentations / Resuscitation 84S (2013) S8–S98
Materials and methods: 46 GPs were participated in our research. All GP’s were asked to perform BLS in two simulated situation: an adult patient with cardiac arrest (resuscitation task) and another adult, unconscious patient (airway task). For data collection a standardized BLS skill assessment sheet was used. For statistical analyses SPSS 15 software was used (Student’s t test, Chi-square). Results: The maximum score was 25 points. The highest score achieved was 16 points, and the lowest is 0 point. Those general practitioners, who have already been performed CPR alone, had averaged 4.5 points in the CPR task, while those who have never had this opportunity, only 2.6 points (p = 0.043). The years spent as a general practitioner negatively influenced the outcome of each task (p = 0.013; p = 0.044). Conclusions: These general practitioners did not meet the minimum requirements that even lay rescuers can expect from a life-saving situation. Those GPs who have been performed CPR on BLS level, performed better. Keywords: BLS; General practitioner; Emergency medicine; Resuscitation.
prompt communication of DNACPR status to the GP, as will the medical clerking proforma to help document consideration of resuscitation on admission. References 1. General Medical Council. Treatment and care towards the end of life: good practice in decision making. London: GMC; 2010. 2. British Medical Association, Resuscitation Council (UK), Royal College of Nursing. Decisions relating to cardiopulmonary resuscitation: a joint statement. London: BMA; 2007.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.184 Mechanical Devices AP159 Mechanical chest compressions and outcome in patients with out-of-hospital cardiac arrest: A registry study Isabella Holm ∗ , Hans Olson, Hans Friberg
http://dx.doi.org/10.1016/j.resuscitation.2013.08.183 AP158 An audit of do not attempt cardiopulmonary resuscitation orders in a District General Hospital Ruth Thomas 1,∗ , Matthew Hough 2 , Lydia Richardson 2 , Charles Warren 2 1
Royal Bournemouth Hospital, Bournemouth, Dorset, UK 2 Dorset County Hospital, Dorchester, Dorset, UK Background: Cardiopulmonary resuscitation (CPR) has the great benefit of potentially prolonging a patient’s life, but the burdens of CPR include trauma, lack of dignity in dying, permanent neurological disability and significant worsening of their chronic medical condition. Due to this there have been recent publications from the General Medical Council (GMC)1 and British Medical Association (BMA)2 on Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions; when they should be made and how they should be documented. Aims: To assess how many patients in Dorset County Hospital had a documented resuscitation discussion and decisions on admission. Those patients with DNACPR decisions were further evaluated to assess documentation against current standards. Method: A 2-part questionnaire was used to audit all adult surgical and medical inpatients over one week in April 2011. Once patients were discharged, notes were reaudited with part 2. Various measures were taken to improve on the results prior to the audit being repeated in October 2012. Results (results for the second audit are in brackets): 249 (233) patients were audited with 39 (61) DNACPR orders in place. 10.8% (20.2%) had resuscitation considered within 24 h of admission. Of the DNACPR patients 100% (98.3%) had a reason documented; 61.5% (83.6%) patients were discharged. In 23% (26%) a consultant did not ratify the decision during the admission. Of those patients that survived to discharge, 95.8% (100%) of DNACPR decisions were still in place but only 4.3% (18.8%) were communicated to the General Practitioner (GP). Conclusions: The results of both audits are again being presented to raise awareness within the hospital and tackle the areas that perform badly (documentation, communication). The Electronic Discharge Summary system will hopefully be amended to
Skåne University Hospital, Lund University, Lund, Sweden Purpose of the study: To investigate the prevalence of reporting and registration of out-of-hospital cardiac arrest (OHCA) patients to a national cardiac arrest registry by the ambulance staff in a region of Sweden during two years (2010–2011). We also investigated the use of a mechanical chest compression device and compared survival rates. Materials and methods: All ambulance records were retrospectively surveyed during the two-year period by examining a regional electronic medical record system (ISPASS) for 2010 and by manually scrutinizing all paper ambulance records for 2011. Patients enrolled in the national cardiac arrest registry were divided into two groups, depending on whether they had received mechanical chest compressions or not. Results: A total of 1348 OHCA patients were identified in the region during the study period, 693 (51%) were reported by the ambulance staff and 655 (49%) were identified and registered retrospectively. Among all OHCA patients, 61.1% received mechanical chest compressions in the region, as compared to 24.7% in the country, but the one-month survival rates were similar; 10.2% versus 10.3%. Survival rates were significantly lower in patients receiving mechanical compressions, 6.5% as compared to 11.1%. Several patient characteristics differed between the groups. Notably, time from alarming the ambulance until defibrillation was significantly longer in patients receiving mechanical CPR (p < 0.05). Conclusions: Only half of all OHCA patients was reported by the ambulance staff in the region, the other half was identified retrospectively. The use of mechanical chest compressions differed significantly between regions, but the overall survival rates were similar. The use of mechanical chest compressions may delay time to defibrillation. http://dx.doi.org/10.1016/j.resuscitation.2013.08.185