A comparison of Not for resuscitation (NFR) forms across five Victorian health services.

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A comparison of Not for resuscitation (NFR) forms across five Victorian health services.

Intern Med J. 2014 Apr 28;

Authors: Levinson M, Mills A, Hutchinson A, Herriot G, Stephenson G, Gellie A

BACKGROUND: Within Australian hospitals cardiac and respiratory arrests result in a resuscitation attempt unless the patient is documented as not for resuscitation.
AIM: To examine the consistency of policies and documentation for withholding in-hospital resuscitation across health services.
METHOD: An observational, qualitative review of hospital policy and documentation, conducted in June 2013 in three public and two private sector hospitals in metropolitan Melbourne. NFR forms were evaluated for physical characteristics; content; authorisation; decision making. Hospital policies were coded for alerts; definition of futility and burden of treatment; management of discussions and dissent RESULTS: A lack of standardisation, with each site using its own unique NFR form and accompanying site specific policies. Differences were found in who could authorise the decision, what was included on the form, the role of patients and families, how discussions were managed and dissent resolved. Futility and burden of treatment were not defined independently. These inconsistencies across sites contribute to a lack of clarity regarding the decision to withhold resuscitation, and have implications for staff employed across multiple hospitals.
CONCLUSIONS: NFR forms should be reviewed and standardised so as to be clear, uniform and consistent with the legislative framework. We propose a two stage process of documentation. Stage 1 facilitates discussion of patient specific goals of care, and consideration of limitations of treatment. Stage 2 serves to communicate an NFR order. Decisions to withhold resuscitation are innately complex but could be aided by separating the decision making process from the communication of the decision, resulting in improved end of life care.

PMID: 24766152 [PubMed - as supplied by publisher]

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