Honouring patient's resuscitation wishes: a multiphased effort to improve identification and documentation

Background Do Not Resuscitate (DNR) orders are intended to safeguard patients' autonomy and prevent unwanted resuscitative care. However, DNR orders may be miscommunicated between health care providers, leading to errors honoring patient wishes during cardiac arrest events. This project focused...

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Veröffentlicht in:BMJ quality & safety 2013-01, Vol.22 (1), p.85-92
Hauptverfasser: Schiebel, Nicola, Henrickson Parker, Sarah, Bessette, Richard R, Cleveland, Eric J, Neeley, J Paul, Warfield, Karen T, Barth, Mellissa M, Gaines, Kim A, Naessens, James M
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Sprache:eng
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Zusammenfassung:Background Do Not Resuscitate (DNR) orders are intended to safeguard patients' autonomy and prevent unwanted resuscitative care. However, DNR orders may be miscommunicated between health care providers, leading to errors honoring patient wishes during cardiac arrest events. This project focused on improving accuracy of DNR ordering processes for an academic, tertiary care hospital. Intervention We describe a performance improvement process and outcomes for implementation of an inpatient electronic ordering system that included an automated, decentralized printing process for resuscitation status armbands. Specific phases of this project involved: (a) identification of common factors contributing to errors honoring patients‘ resuscitation wishes, (b) design of an electronic ordering process, (c) design and integration of a new DNR armband and (d) evaluation of the impact of changes on communication accuracy. The primary outcome was percentage of patients with incorrect designation of resuscitation status on armbands compared to the active resuscitation order in the electronic medical record. Results After implementation of an electronic ordering process we identified that 37/196 (19%) patients had an armband that did not reflect their documented wishes versus 2/103 (2%) after integration of automated armband printing into the process (p
ISSN:2044-5415
2044-5423
DOI:10.1136/bmjqs-2012-000928