Abstract 3345
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
| Before Intervention | After Intervention | |
|---|---|---|
| DNACPR discussed by own team | 11% | 54% |
| DNACPR discussed by oncology team | 29% | 92% |
| DNACPR discussed in daytime | 24% | 77% |
| Mean time to implement DNACPR | 4 days | 2.5 days |
| DNACPR implemented and patient discharged home | 5% | 54% |
| DNACPR not implemented in eligible patient – died following CPR | 44% | 12% |
| Documentation of escalation plan | 30% | 85% |
| Documentation of prognosis | 25% | 54% |
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.
Resources from the same session
3371 - Pulmonary Resectable Metastases of Osteosarcoma With Apatinib and CHemotherapy (PROACH)：A Multi-Center Phase II Randomized Clinical Trial
Presenter: Qiyuan Bao
Session: Poster Display session 1
Resources:
Abstract
1666 - National Clinical-biological Prospective Cohort of Incident Cases of Aggressive Fibromatosis, AF (ALTITUDES)
Presenter: Thomas Ryckewaert
Session: Poster Display session 1
Resources:
Abstract
5531 - Health-related quality Of Life In patients with advanced Soft TIssue sarcomas treated with Chemotherapy: The HOLISTIC study
Presenter: Eugenie Younger
Session: Poster Display session 1
Resources:
Abstract
5568 - Assessing QUality of life and Experiences of diagnostic Trajectories of Sarcoma patients: The QUEST study protocol
Presenter: Vicky Soomers
Session: Poster Display session 1
Resources:
Abstract