QI Project: Perioperative DNR Policy WHO? & MAY 8, 2017 WHAT? QI Project: Perioperative DNR Policy Residents: Andy Gruel, Sam Wallum, Lyndsey Graber Advisors: Cristina Wood, Marina Shindell

Those with a DNR sometimes need surgery also WHAT?? The Perioperative DNR Policy [ ] Those with a DNR sometimes need surgery also

… Many involving communication breakdown and policy confusion Including: events of DNR patients receiving full CPR !! … Many involving communication breakdown and policy confusion At LEAST 9 KNOWN Perioperative QI Events involving patients with DNR status going to the OR recently Why…

{GASP!}

10 min. Educational Presentation on Current Policy How: ed·u·cate /’ejə,kāt/ To give intellectual, moral, and social instruction to (someone, especially a child), typically at a school or university. synonyms: teach, school, tutor, instruct, coach, train, drill, Moreguide, inform, enlighten, inculcate, indoctrinate, upskill, formaledify 10 min. Educational Presentation on Current Policy TO: #1 Anesthesia Providers #2 AIP Pre-op Nurses #3 AIP PACU Nurses #4 AOP Pre-op and PACU Nurses Included: Pre-Test Questions, Post-Test Questions, and Free-text Suggestion Section

Free-Text Feedback Decreased knowledge of the process Unclear who is assigned to do what Code status should be addressed before patient is in Pre-op Free-Text Feedback Stressful for providers and patients Not every patient has any kind of code status order during their admission Extremely time consuming and confusing process

Additional Project Results #1 Meeting with hospital DNR Policy review/QI Group Additional Project Results #2 Possible addition to Pre-op RN questions to add specific DNR text #4 Discussion with Timeout QI group about addition of code status Possible code status addition to Surgery Teams’ Admit orders #3 Looking into patient DNR status button in Anesthesia Pre-op evaluation #5

Dr. Cristina Wood Dr. Marina Shindell Gabrielle Ingalsbe Dr. Tobias Eckle Dr. Melanie Donnelly Dr. Allison Brainard