Implementing a resuscitation plan – Does it work?

Decisions to provide or limit medical treatments, such as cardiopulmonary resuscitation (CPR) and mechanical ventilation are often made during acute hospital admissions. These decisions are made by a) doctors, based on the anticipated potential benefit or harm to the patient, b) the patient or c) a surrogate, based on the patient’s wishes. These decisions then need to be recorded and accessible if they need to be acted upon. In our hospital we have previously completed a “not-forresuscitation” form. This form was often absent or completed poorly or ambiguously and did not document a) limitation of lifeprolonging treatments other than CPR, b) how the decisions had been made, or c) with whom decisions had been discussed.

A new form, the “Resuscitation Plan” (RP) clearly documents whether treatment is primarily aimed at prolonging life (4 options available including full treatment) or at symptom management. The reason for the decision, and whether patient/family has been informed of the decision, is also recorded. The form is a tick box format, and the information must also be recorded on the hospital computer record. The reverse side of the RP contains a medical decision-making flow chart to assist doctors in their decision-making. A life-prolonging treatment policy has been developed to support the RP and an extensive education program for all clinical staff has occurred.

An evaluation of the success, effectiveness and completion rate of the RP and the compliance with the hospital life-prolonging treatment policy will be presented.