Honouring patient's resuscitation wishes: A multiphased effort to improve identification and documentation

Nicola Schiebel, Sarah Henrickson Parker, Richard R. Bessette, Eric J. Cleveland, J. Paul Neeley, Karen T. Warfield, Mellissa M. Barth, Kim A. Gaines, James M Naessens

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Do Not Resuscitate (DNR) orders are intended to safeguard patients' autonomy and prevent unwanted resuscitative care. However, DNR orders may be miscommunicated between health care providers, leading to errors honoring patient wishes during cardiac arrest events. This project focused on improving accuracy of DNR ordering processes for an academic, tertiary care hospital. Intervention: We describe a performance improvement process and outcomes for implementation of an inpatient electronic ordering system that included an automated, decentralized printing process for resuscitation status armbands. Specific phases of this project involved: (a) identification of common factors contributing to errors honoring patients' resuscitation wishes, (b) design of an electronic ordering process, (c) design and integration of a new DNR armband and (d) evaluation of the impact of changes on communication accuracy. The primary outcome was percentage of patients with incorrect designation of resuscitation status on armbands compared to the active resuscitation order in the electronic medical record. Results: After implementation of an electronic ordering process we identified that 37/196 (19%) patients had an armband that did not reflect their documented wishes versus 2/103 (2%) after integration of automated armband printing into the process (p<0.001). No armband discrepancies were found after the first two weeks of post-implementation audits. Conclusions: Design and implementation of an electronic ordering and armband labeling process reduced discrepancies between patient wishes and the armband labeling of the patient's desired DNR status. It is anticipated that these improvements will reduce the risk of adverse outcomes, and better align clinical processes with patient wishes.

Original languageEnglish (US)
Pages (from-to)85-92
Number of pages8
JournalBMJ Quality and Safety
Volume22
Issue number1
DOIs
StatePublished - Jan 2013

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Resuscitation
Documentation
Resuscitation Orders
Printing
Electronic Health Records
Tertiary Healthcare
Heart Arrest
Tertiary Care Centers
Health Personnel
Inpatients
Communication

ASJC Scopus subject areas

  • Health Policy

Cite this

Honouring patient's resuscitation wishes : A multiphased effort to improve identification and documentation. / Schiebel, Nicola; Parker, Sarah Henrickson; Bessette, Richard R.; Cleveland, Eric J.; Neeley, J. Paul; Warfield, Karen T.; Barth, Mellissa M.; Gaines, Kim A.; Naessens, James M.

In: BMJ Quality and Safety, Vol. 22, No. 1, 01.2013, p. 85-92.

Research output: Contribution to journalArticle

Schiebel, N, Parker, SH, Bessette, RR, Cleveland, EJ, Neeley, JP, Warfield, KT, Barth, MM, Gaines, KA & Naessens, JM 2013, 'Honouring patient's resuscitation wishes: A multiphased effort to improve identification and documentation', BMJ Quality and Safety, vol. 22, no. 1, pp. 85-92. https://doi.org/10.1136/bmjqs-2012-000928
Schiebel, Nicola ; Parker, Sarah Henrickson ; Bessette, Richard R. ; Cleveland, Eric J. ; Neeley, J. Paul ; Warfield, Karen T. ; Barth, Mellissa M. ; Gaines, Kim A. ; Naessens, James M. / Honouring patient's resuscitation wishes : A multiphased effort to improve identification and documentation. In: BMJ Quality and Safety. 2013 ; Vol. 22, No. 1. pp. 85-92.
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abstract = "Background: Do Not Resuscitate (DNR) orders are intended to safeguard patients' autonomy and prevent unwanted resuscitative care. However, DNR orders may be miscommunicated between health care providers, leading to errors honoring patient wishes during cardiac arrest events. This project focused on improving accuracy of DNR ordering processes for an academic, tertiary care hospital. Intervention: We describe a performance improvement process and outcomes for implementation of an inpatient electronic ordering system that included an automated, decentralized printing process for resuscitation status armbands. Specific phases of this project involved: (a) identification of common factors contributing to errors honoring patients' resuscitation wishes, (b) design of an electronic ordering process, (c) design and integration of a new DNR armband and (d) evaluation of the impact of changes on communication accuracy. The primary outcome was percentage of patients with incorrect designation of resuscitation status on armbands compared to the active resuscitation order in the electronic medical record. Results: After implementation of an electronic ordering process we identified that 37/196 (19{\%}) patients had an armband that did not reflect their documented wishes versus 2/103 (2{\%}) after integration of automated armband printing into the process (p<0.001). No armband discrepancies were found after the first two weeks of post-implementation audits. Conclusions: Design and implementation of an electronic ordering and armband labeling process reduced discrepancies between patient wishes and the armband labeling of the patient's desired DNR status. It is anticipated that these improvements will reduce the risk of adverse outcomes, and better align clinical processes with patient wishes.",
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