The BBC News has reported that the British Medical Association and the Royal College of Nursing in the UK have issued guidelines which indicated that the DNR orders could be issued only in consultation with the patients and families (BBC Ethics Guide, 2011). In Australia, the not-for-resuscitation (NFR) orders formed part of the medical practice but policies have still not yet provided a fool-proof method of implementation (Sidhu et al, 2007). Researchers indicate that current policies showroom for improvement: there are no standardised forms or patient information leaflets (Sidhu et al, 2007). A clinical audit had been conducted by Salins and Jansen as a retrospective study to determine the accuracy of documentation of NFR orders in patients who had died at the Lyell McEwin Hospital (2011).
This hospital was part of a teaching hospital in South Australia in 2007. Eighty-eight files could be accessed for information. Senior Registered Nurses from the Hospital’ s Palliative Care Service participated in completing the questionnaires (Salins and Jansen, 2011). Most of the patients (96.59%) had an NFR documented in their case sheets. Only 3 patients did not have an NFR documented; two of them had been cancer patients but had not been in-patients in the palliative care. 06 % cases, the documentation was because the patients had specifically declined resuscitation if a cardiac arrest occurred.
Some patients (27.06%) decided on NFR as they were sure of having a poor quality of life if resuscitated (Salins and Jansen, 2011). Patients who were mentally incompetent (17.65%) had a surrogate decision-maker. More case sheets (52.94%) indicated a documented discussion about prognosis while only 40% had evidence of an appropriate diagnosis. Sixty-six % cases had received palliative care.
CPR procedure or the chances of its successful outcome had not been mentioned (Salins and Jansen, 2011). The case sheets did not have many essential parts like a name of the doctor (3 nos. ), time of entry (50%), grade of the doctor (75.3%), translation of medical notes to nursing notes (75%) and usage of right terminology (11. The NFR decision was documented at the instance of the consultants in 32.94% cases while in 66.66% the junior doctor had documented the NFR but the consultant had seen the patient within 2 days after the documentation.
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