1. Audit of National DNAR Policy Implementation St. Columcille’s Hospital Dr Marie Therese Cooney & Dr Crina Burlacu On behalf of: MT Cooney, P Mitchell, I Ioana, A Haia, D Stancila, C Burlacu

2. Background: National consent policy was introduced in 2013 New policy also deals with do not attempt resuscitation (DNAR) orders (Part IV) Clarifies the information which should be documented Consent committee was formed in St Columcille’s hospital to consider the introduction of this policy.

3. Standard: National Consent Policy Section 8 (Part IV) - Documenting and communicating CPR/DNAR decisions A decision whether or not to attempt CPR should be clearly and accurately documented in the individual’s healthcare record  how the decision was made  the date of the decision  the rationale for it  who was involved in discussing the decision.  Recommended the development of a standardised and colour‐coded DNAR card, to be included in an individual’s records, to help highlight his/her DNAR status

4. Standard: National Consent Policy Section 9 (Part IV) - Reviewing DNAR orders Review decisions relating to CPR when:  the individual’s clinical condition changes  the individual’s preferences regarding CPR change  an individual who previously lacked decision‐making capacity regains his/her capacity  clinical responsibility for the individual changes (e.g. where he/she is being transferred or discharged). Any review and any subsequent decision made should be documented accordingly. *An extra point was added to the above for SCH, in line with the previous policy:  A date for review of DNAR decision should be entered at the time of completion of the DNAR form

5. Aims: To assess the number of patients in the St Columcille’s Hospital, Loughlinstown with DNAR orders in place. To assess the documentation of these, specifically: 1.Was a clear note documenting DNAR in the medical notes? 2.Was the DNAR form completed and placed in the chart as per SCH policy? 3.Was a review date entered on the form? 4.Where present, was the review date expired?

6. Results:

7. First Change implemented Presentation of results of current audit at lunchtime conference attended by all NCHDs and most consultants including medical, surgical and anaesthetic teams Current deficiencies regarding documentation were highlighted Outlined the need to meet the standards detailed in the national consent policy. Completed on 10 th March 2014.

8. First Re-audit Results

9. Second Change Implemented Modification of the current SCH DNAR form in line with the specific recommendations of the national consent policy. Changes: highlighting the documentation requirements need for review to document when this review of DNAR decisions have been made national consent policy is referenced summary of the relevant sections is available on the back of the form need for medical staff to be reminded when the review date is approaching is clearly highlighted on the new form.

10. Second Re-audit Results

11. Overall Conclusions: Since the initial audit there has been: Substantial improvement in the percentage with DNAR documented on the appropriate DNAR form, now 100% This continued to be seen in the second re-audit. However, 70% of forms were incomplete with no review date entered, but no expired DNAR forms. In the second re-audit, however, there were still 62.5% of forms missing a review date and the review date was expired in 33% of complete forms. This highlights the need for continued and ongoing education of rotating non-consultant hospital doctors on the need for complete documentation of DNAR orders.

12. Thank you