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CPR or DNR? End-of-life decision making on a family practice teaching ward.
Can Fam Physician. 2000 Feb; 46:340-6.CF

Abstract

OBJECTIVE

To determine the proportion of patients on a family practice ward who had "code status" orders and end-of-life discussions documented on their charts in the first week of admission. To examine the correlation between a tool predicting the likelihood of benefit from cardiopulmonary resuscitation (CPR) and actual end-of-life decisions made by family physicians and their patients.

DESIGN

Cross-sectional descriptive study using a retrospective chart review.

SETTING

A 14-bed teaching ward where family physicians admit and manage their own patients in an urban tertiary care teaching hospital.

PARTICIPANTS

Patients admitted to the ward for 7 or more days between December 1, 1995, and August 31, 1996.

MAIN OUTCOME MEASURES

Frequency of documented "do not resuscitate" (DNR) or "full code" orders and documented end-of-life discussions. Prognosis-after-resuscitation (PAR) score.

RESULTS

In the 103 charts reviewed, code status orders were entered within 7 days for 60 patients (58%); 31 were DNR, and 29 were full code. Discussion of code status was documented in 25% of charts. The PAR score for 40% of patients was higher than 5, indicating they were unlikely to survive to discharge from hospital should they require CPR. There was a significant association between PAR scores done retrospectively and actual code status decisions made by attending family physicians (P < .005).

CONCLUSIONS

End-of-life discussions and decisions were not fully documented in patients' charts, even though patients were being cared for in hospital by their family physicians. A PAR score obtained during the first week of admission could assist physicians in discussing end-of-life orders with their patients.

Authors+Show Affiliations

St Paul's Hospital Site, Vancouver, BC. bcalam@stpaulshosp.bc.caNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10690490

Citation

Calam, B, and R Andrew. "CPR or DNR? End-of-life Decision Making On a Family Practice Teaching Ward." Canadian Family Physician Medecin De Famille Canadien, vol. 46, 2000, pp. 340-6.
Calam B, Andrew R. CPR or DNR? End-of-life decision making on a family practice teaching ward. Can Fam Physician. 2000;46:340-6.
Calam, B., & Andrew, R. (2000). CPR or DNR? End-of-life decision making on a family practice teaching ward. Canadian Family Physician Medecin De Famille Canadien, 46, 340-6.
Calam B, Andrew R. CPR or DNR? End-of-life Decision Making On a Family Practice Teaching Ward. Can Fam Physician. 2000;46:340-6. PubMed PMID: 10690490.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - CPR or DNR? End-of-life decision making on a family practice teaching ward. AU - Calam,B, AU - Andrew,R, PY - 2000/2/26/pubmed PY - 2000/3/18/medline PY - 2000/2/26/entrez KW - Death and Euthanasia KW - Empirical Approach SP - 340 EP - 6 JF - Canadian family physician Medecin de famille canadien JO - Can Fam Physician VL - 46 N2 - OBJECTIVE: To determine the proportion of patients on a family practice ward who had "code status" orders and end-of-life discussions documented on their charts in the first week of admission. To examine the correlation between a tool predicting the likelihood of benefit from cardiopulmonary resuscitation (CPR) and actual end-of-life decisions made by family physicians and their patients. DESIGN: Cross-sectional descriptive study using a retrospective chart review. SETTING: A 14-bed teaching ward where family physicians admit and manage their own patients in an urban tertiary care teaching hospital. PARTICIPANTS: Patients admitted to the ward for 7 or more days between December 1, 1995, and August 31, 1996. MAIN OUTCOME MEASURES: Frequency of documented "do not resuscitate" (DNR) or "full code" orders and documented end-of-life discussions. Prognosis-after-resuscitation (PAR) score. RESULTS: In the 103 charts reviewed, code status orders were entered within 7 days for 60 patients (58%); 31 were DNR, and 29 were full code. Discussion of code status was documented in 25% of charts. The PAR score for 40% of patients was higher than 5, indicating they were unlikely to survive to discharge from hospital should they require CPR. There was a significant association between PAR scores done retrospectively and actual code status decisions made by attending family physicians (P < .005). CONCLUSIONS: End-of-life discussions and decisions were not fully documented in patients' charts, even though patients were being cared for in hospital by their family physicians. A PAR score obtained during the first week of admission could assist physicians in discussing end-of-life orders with their patients. SN - 0008-350X UR - https://www.unboundmedicine.com/medline/citation/10690490/CPR_or_DNR_End_of_life_decision_making_on_a_family_practice_teaching_ward_ L2 - http://www.cfp.ca/cgi/pmidlookup?view=long&amp;pmid=10690490 DB - PRIME DP - Unbound Medicine ER -