3345 - Escalation plans and DNACPR discussions in the unwell oncology patient

Background

Patients with advanced end stage cancer have < 1% chance of spontaneous circulation following cardiopulmonary resuscitation (CPR). Effective communication in a timely manner is best practice to ensure DNACPR (Do not attempt cardiopulmonary resuscitation) decisions are implemented correctly, well understood by patients/relatives and to avoid unnecessary CPR. Previous audit data at LRI and clinician experience indicated that oncology inpatients were having significant delays in DNACPR discussions. In many cases DNACPR decisions were occurring in emergency clinical situations by out of hours on-call medical staff.

Methods

We identified unwell (early warning score >5) oncology inpatients admitted to LRI. Using a data collection tool, we primarily identified the proportion of patients who had a DNACPR decision. Furthermore, we analysed timeliness of DNACPR decisions, involvement of patients’ own oncology team and documentation of prognosis/escalation plans. Liaising with healthcare professionals from oncology & palliative care we formulated ideas to improve outcomes. Enhancing communication between permanent ward staff (nurses & junior doctors) and senior decision makers (oncology registrars & consultants) was vital to improve outcomes. We therefore empowered junior doctors/nursing staff to identify patients who needed DNACPR discussions using a proforma tool utilising board round meetings as a platform. Data was then analysed to compare outcomes.

Results

Qualitative data showed improved confidence for junior doctors in identifying & communicating DNACPR discussions.Table:

1598P

Conclusions

Empowering junior doctors and simple departmental changes lead to a significant improvement in communicating and implementing DNACPR decisions. We therefore significantly reduced unnecessary CPR attempts and subsequently improved communication and documentation of escalation plans and prognosis. We believe our model can be implemented in other oncology centres and look forward to discussing this further.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

National Health Service, UK.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.