Abstract
Background: This improvement project was done within the Geriatrics/ Stroke department and aims to meet the following adapted standards: all discharged patients must leave with the original DNACPR document, and clear documentation of their DNACPR and review status in the immediate discharge letter to their Primary care provider.
Local problem: Firstly, not all discharged patients leave with the original DNACPR document and secondly, their DNACPR status was not communicated to their Primary care provider which highlights a communication gap which exists between secondary and primary care.
Methods: Retrospective data on frail and critically ill patients who had a DNACPR form within the last twenty days were collected from medical records. The review showed whether the original document was given to the patient upon discharge and if information was communicated to the Primary care provider within the immediate discharge letter.
Interventions: To implement changes, email communications were disseminated to the Geriatrics/ Stroke team, posters displayed in prominent locations around the Geriatric/ Stroke wards, a message prompt was added to the clinical progress section of the electronic immediate discharge letter and education was given to the ward clerks to ensure the patient’s original DNACPR document is given to them on discharge and a copy kept on their paper medical case notes.
Results: In twenty days, a total of twenty-eight patients were discharged from the respective wards, of which nine met the criteria. Only two, were discharged with the original DNACPR form and none of the DNACPR decisions were communicated to Primary Care.
Conclusion: This project is ongoing and aims to collect quantitative data biweekly. At the end of the cycle, we aim to achieve 40% improvement in DNACPR status communication to primary care and 30% increase in patients being discharged with the original document by October 2024.