Despite being in existence for over 30 years,1 the implementation and recording of do not attempt resuscitation (DNAR) orders is often poor.2 Orders are often not issued when required and patient involvement in decision making is sub-optimal.2 This review set out to identify interventions to improve implementation of in-hospital adult DNAR orders

Baker, Annalie

Field, Richard A

Perkins, Gavin D

Resuscitation

Heart of England: HEFT Repository

e uscitaAScR12ttwoiwc“trDiaTteeDthpMpFiaR[1[2hAPEcccmawaw4[1[2[3122 Poster Presentations / ResP255ystematic review of interventions to improve outcomes asso-iated with do-not-attempt-resuscitation ordersichard Field1,∗, Gavin Perkins1, Annalie Baker2University of Warwick/Heart of England NHS Trust, Warwick, UKHeart of England NHS Trust, Birmingham, UKPurpose of study:Despite being in existence for over 30 years,1he implementation and recording of do not attempt resuscita-ion (DNAR) orders is often poor.2 Orders are often not issuedhen required and patient involvement in decision making is sub-ptimal.2 This review set out to identify interventions to improvemplementation of in-hospital adult DNAR orders.Materials and methods: Ovid Medline (1996-February 2012)as searched using “DNAR” OR “DNR” OR “do not attempt resus-itation” as text words. The search was combined using OR withresuscitation orders” as a MeSH term. The search was limited tohe last 10 years and English language.Results: 900 citations were identiﬁed of which 10 studies wereelevant. Three studies investigated the introduction of pre-printedNAR forms. Two studies investigated the effect ofmodifying exist-ng forms. Two studies investigated staff educational interventionsnd a further two investigated patient educational intervention.he remaining study investigated the impact medical emergencyeams have on issuing DNAR orders.Conclusions: The use of pre-printed forms can help ensure keylements of the DNAR decision are recorded and modiﬁcation ofxisting forms can help address factors which are poorly recorded.espite the beneﬁt in documentation forms alone do not changeheprevalence ofDNARorders. The role of staff education is unclearowever patient educational interventions which actively engageatients on admission improve recording of their CPR preferences.edical emergency teams are more likely to issue DNARs com-ared to standard emergency teams the reason for this is unclear.urther research is needed to identify effective interventionswhichmprove identiﬁcation of patients for whom resuscitation is notppropriate.eference].Rabkin MT, et al. N Engl J Med 1976;295:336–64.].Meilink M, et al. Resuscitation 2006;71:322–6.ttp://dx.doi.org/10.1016/j.resuscitation.2012.08.314P256resence of familymembers during care of critically ill patientslena Suhanek ∗, Marija Kojicic, Zlatko Fiser, Violetta RaffaySerbian resuscitation Council, Novi Sad, SerbiaEthical issue of the presence of family members during care ofritically ill patients is always controversial among physicians.The objective of research is to determine the attitude that physi-ians take about the presence of family members during care ofritically ill patients.Prospective internet surveywas randomlydistributed to2000e-ail addresses among physicians practicing in primary, secondarynd teriary health care centres in Vojvodina. Results of the surveyere collected between Nov. 18 and Dec. 28 in 2011. Results werenalyzed with statistical analysis program SPSS.The survey resulted with 119 answers. 50/119 (42%)answersere from primary health care, 20/119 (17%) from secondary and8/119 (40%) from teriary health care. 93/119 (78%) physicians pro-tion 83 (2012) e24–e123vided feedbackwere involved in careof critically ill patients. 61/119(51%) physicians reported presence of family members during careof adult critically ill patients not beneﬁcial. 94/119 (79%) physicianspreferred no family members presence during procedures. 32/119(27%) physicians thought that presence of family during proce-dure was beneﬁcial for patients. 57/119 (48%) physicians reportedpresence of family as beneﬁcial for family members themselvesevenduringmedical interventionswhichhad fatal outcome78/119(66%) physicians reported beneﬁts from communication with thefamily about the events and medical history of the patient whichresulted in speciﬁc intervention. 38/119 (32%) physicians workedin institutions where visit from priest was available for criticallyill patients. Church spot existed in institutions where 34/119 (29%)physicians worked. Majority of physicians 52/119 (44%) rated theirknowledge and skills as 4 out of 5 for the care of the critically illpatient which they provided.The ethical question of the rights about family presence duringcritical procedures in Serbia is not determined yet in legislation andit is still left to the discretion of the physician.Further reading].Leung NY, Chow SK. Attitudes of healthcare staff and patients’ family memberstowards family presence during resuscitation in adult critical care units. J ClinNurs 2012;21:2083–93.].WachtO,Dopelt K, Snir Y, DavidovitchN. Attitudes of emergencydepartment stafftoward family presence during resuscitation. Isr Med Assoc J 2010;12:366–70.].Feagan LM, Fisher NJ. The impact of education on provider attitudes towardfamily-witnessed resuscitation. J Emerg Nurs 2011;37:231–9.http://dx.doi.org/10.1016/j.resuscitation.2012.08.315AP257Attitude of elderly patients towards cardiopulmonary resusci-tation in GreeceAthanasios Chalkias ∗, Daphne Chliara, Evangelos Horopanitis,Theodoros XanthosNational and Kapodistrian University of Athens, Medical School,Department of Anatomy, Athens, GreecePurpose of the study: It is important that healthcare providersunderstand the principles of end-of-life decisions before they arefaced with a situation where a decision to resuscitate or not mustbe made. The aim of our study was to determine the attitude ofhospitalized older patients towards cardiopulmonary resuscitation(CPR).Materials andmethods:Weconducted a surveyusing onebasicquestionnaire in ﬁve different hospitals in Greece from June toNovember 2010.Results: In total, 300 questionnaires were collected. Althoughpatients’ knowledge regarding CPR is poor, most of them (87.7%)would like to be resuscitated in case they suffered an in-hospitalcardiac arrest. The good quality of life (p=0.003), high educationallevel (p=0.002), increased knowledge regarding CPR (p=0.036),and the strong relationship with their family members (p=0.020)were associated with increased willingness to accept resuscitationin case of in-hospital cardiac arrest. However, the inﬂuence of sev-eral factors, such as their general health status or the underlyingpathology, may lead patients to give a ‘do-not-attempt resuscita-tion’ order.Conclusions: Most of the older patients would like to undergoCPR in case they suffer an in-hospital cardiac arrest and believe thatthey shouldhave the right toacceptordeny treatment.Medicalper-sonnel may play a central role in patient education regarding CPR.We advocate the introduction of advanced directives, as well as the

Systematic review of interventions to improve outcomes associated with do-not-attempt-resuscitation orders

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