Diggory Paul, Cauchi Lisa, Griffith David, Jones Valerie, Lawrence Enas, Mehta Anand, O'Mahony Paul, Vigus Jane
Department of Medicine for the Elderly, Mayday University Hospital, Croydon, London, UK.
Resuscitation. 2003 Feb;56(2):159-65. doi: 10.1016/s0300-9572(02)00349-0.
Current guidelines advise discussion with patients before issuing a 'do not attempt resuscitation' (DNAR) order. We report five audit cycles of cardiopulmonary resuscitation (CPR) documentation after introducing a proforma, the last cycle following the latest guidelines. In first audit data were collected from 75 patient discharges. CPR decisions were documented in 27 (36%). Four subsequent point prevalence audits carried out on all inpatients following proforma introduction showed documentation improved to 102/109 (94%), 135/148 (91%), 131/140 (94%) and 102/119 (86%) in cycles two, three, four and five, respectively. The last three audits also revealed that consultants consistently made more DNAR orders than trainee doctors. However, following the introduction of the latest guidelines the proportion of patients in whom a decision was made, and the percentage of those decisions that were DNAR, fell.
当前指南建议在下达“不要尝试心肺复苏”（DNAR）医嘱前与患者进行讨论。我们报告了在引入一种表格后进行的五个心肺复苏（CPR）记录审核周期，最后一个周期遵循最新指南。在首次审核中，从75例患者出院记录中收集数据。CPR决策记录于27例（36%）。在引入表格后，对所有住院患者进行的四次后续现患率审核显示，在第二、三、四和五个周期中，记录率分别提高到102/109（94%）、135/148（91%）、131/140（94%）和102/119（86%）。最后三次审核还显示，顾问医生下达的DNAR医嘱始终多于实习医生。然而，在引入最新指南后，做出决策的患者比例以及其中DNAR决策的百分比均下降。
