Friday, June 1, 2012

New Report on DNR: Time to Intervene?

The UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has released a new report that highlights the process of care for adult patients who received cardiopulmonary resuscitation in an in-hospital setting.  

The report takes a critical look at areas where the care of patients might have been improved, and factors which may have affected the decision to initiate a resuscitation attempt. Notably, the report found that even when a DNACPR decision had been made it was not always followed, and 52 patients underwent CPR despite their explicit DNACPR decision.

NCEPOD Chairman Bertie Leigh said that he hoped this report would prompt a rethink on the limits of what is possible, and act as a wake up call to the NHS: “In nearly half of all the cases we reviewed there was a failure to formulate an appropriate care plan on admission, and a failure, often over several days, to find out what the patient’s wishes were – and to carry them out.”  “We are at a crossroads. All of us need to recognise and accept the limits of what can be achieved in medicine to the benefit of the patient, and a ‘ceiling of treatment’ described and agreed with the patient wherever possible. Doctors should only administer CPR where a patient has consented, or if the doctor is satisfied it is in the patient’s best interests.”

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