Background Do Not Attempt Resuscitation (DNAR) orders are implemented to obviate inappropriate Cardio-Pulmonary Resuscitation (CPR) in patients with low chances of survival post-CPR. However, ambiguity regarding ceilings of care for patients with a DNAR order can arise. This re-audit aimed to review DNAR and ceilings of care documentation according to national HSE guidelines after education sessions, comparing results with the pre-education audit in a Model 3 Hospital. Methods A point-prevalence chart review of thirty-one adult medical inpatients with a DNAR order was conducted after two education sessions were held for Non-Consultant Hospital Doctors (NCHDs) and Consultants. Results Of all thirty-one charts, 35% documented DNAR status in the medical notes, with 32% documenting the reasoning for DNAR status, both of which were unchanged from the first audit cycle. There was an increase in documentation of patient discussion (61% versus 45%) and reasons if this was excluded (66% versus 41%). There was no change in documentation of patient relatives’ discussion (48%) but there was an increase in the reasons if this was excluded (25% versus 18%). There was an overall increase in ceilings of care documentation for ICU admission (three-fold increase), intubation (two-fold increase), inotropic support, and comfort measures, but rates of documentation were still less than 15%. This elucidates the efficacy of education sessions in improving DNAR documentation adherence. Recent studies have highlighted uncertainty among NCHDs regarding treatment escalation in acutely unwell patients in the absence of adequately filled DNAR orders and clear documentation of ceilings of care. Therefore, we posit the introduction of a Ceilings of Care document, akin to the United Kingdom’s Medical Advance Plan. Conclusion Accurate recording of DNAR status and ceilings of care is essential for quality care and treatment escalation. While simple education strategies have proven beneficial in enhancing compliance, additional efforts are needed to enhance ceilings of care documentation.

中文翻译：

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DNAR：全有或全无：模型 3 医院教育课程重新审核的影响


背景 实施“请勿尝试复苏”(DNAR) 命令是为了避免对 CPR 后存活机会较低的患者进行不适当的心肺复苏 (CPR)。然而，对于持有 DNAR 订单的患者的护理上限可能会出现模糊性。这次重新审核的目的是在教育课程结束后根据国家 HSE 指南审查 DNAR 和护理文件的上限，并将结果与​​ Model 3 医院的教育前审核进行比较。方法 在为非顾问医院医生 (NCHD) 和顾问举办两次教育课程后，对 31 名持有 DNAR 订单的成人住院患者进行了点患病率图表审查。结果 在所有 31 个图表中，35% 在医疗记录中记录了 DNAR 状态，32% 记录了 DNAR 状态的推理，这两者与第一个审核周期相比没有变化。患者讨论的记录有所增加（61% 对比 45%），以及排除这种情况的原因（66% 对比 41%）。患者亲属讨论的记录没有变化（48%），但如果排除这种情况，原因会增加（25% 对比 18%）。 ICU 入住（增加三倍）、插管（增加两倍）、正性肌力支持和舒适措施的护理记录上限总体增加，但记录率仍低于 15%。这阐明了教育课程在提高 DNAR 文档依从性方面的功效。最近的研究强调了 NCHD 在缺乏充分填写的 DNAR 订单和明确的护理上限记录的情况下，对于严重不适患者的治疗升级存在不确定性。 因此，我们提出引入护理上限文件，类似于英国的医疗预支计划。结论 准确记录 DNAR 状态和护理上限对于优质护理和治疗升级至关重要。虽然简单的教育策略已被证明有助于提高依从性，但还需要付出更多努力来提高护理记录的上限。