Staff Awareness of a ‘Do Not Attempt Resuscitation’ Policy in a District General Hospital
This source preferred by Gary Smith
Authors: Smith, G.B., Poplett, N. and Williams, D.
UK hospitals have been instructed to ensure that all staff understand the institution's resuscitation policy. Using a questionnaire, we determined the level of knowledge about the hospital's ‘do not attempt resuscitation’ (DNAR) policy amongst a range of staff.
Six hundred and seventy-seven questionnaires were returned. 91.4% of responders did not know the correct overall percentage survival to hospital discharge following an in-hospital cardiac arrest. 19.3% of doctors, 10.6% of nurses, and 8.9% of health care support workers (HCSW) gave answers in the correct range (i.e., 15–25%).
Most doctors (93.5%), nurses (93.5%), and HCSW (78.9%) correctly identified that cardiopulmonary resuscitation (CPR) should be the default position, when a DNAR decision does not exist. The majority of doctors (78.5%), nurses (73.2%) and HCSW (65.8%) appreciated that the hospital policy allowed a senior trainee doctor (specialist registrar; SpR) to make the initial decision without consultation with more senior medical staff. Knowledge of who was ultimately responsible for the DNAR decision was also good, with 100% of doctors, 100% of midwives, 98.3% of nurses and 78.9% of HCSW responding correctly.
Ten percent of doctors, 15% of nurses and 10.5% of HCSW believed that the next of kin could demand resuscitation or a DNAR status. There was inconsistency about what information staff felt should be included in DNAR documentation and what, if any, continuing care should be given to patients who are not for resuscitation.
Our study demonstrates that there is room for improvement in the awareness of staff about the DNAR process. The local DNAR policy is being reviewed to ensure that its messages are clear and a specific DNAR educational programme has been commenced.