SP - Ethics and Law

Aims 

Understanding patients' wishes regarding CPR before surgery is crucial. This study aims to assess the impact of a Do Not attempt Cardiopulmonary Resuscitation (DNACPR) decision on anaesthetists actions during theatre. 

Methods 

We used WhatsApp, to present a scenario of an 83-year-old with ischaemic heart disease, cognitive impairment, and an acute hip fracture. Anaesthetists were asked how they would handle various intraoperative events and whether a prior DNCPPR would influence their actions. 

Results 

A Total of 74 UK anaesthetists all but one of them consultants completed the annoymous survey. A surprising number N=27 (37%) of respondents indicated that prior knowledge of a DNACPR decision would have altered their preparedness to anaesthetise the patient. 

Despite a pre-existing DNACPR decision N=68 (92%) stated that they would attempt electrical cardioversion if the patient became hypotensive with a regular broad complex tachycardia, as would N=65 (88%) in response to ventricular fibrillation during surgery. N=36 (49%) would initiate chest compressions in theatre if the patients failed to respond to electrical cardioversion, but only N=2 (3%) would continue with intubation, ventilation and discussion with critical care if the patient failed to respons to three cycles of compressions and cardioversion. 

Conclusion 

It is important for anaesthetists to discuss the nuances of different elements of CPR as part of patients' pre-operative assessment as it is much more likely to be successful in theatre than in the ward in community settings that most DNACPR discussions with consider. 

Raising the topic of resuscitation can lead to anxiety among patients and their families. Our study has shown that most anaesthetists will set aside a DNACPR decision anyway if problems arise in theatre. 

It may be more important to identify existing DNACPR decisions for discussion rather than introducing new resuscitation questions, which may distress patients without changing anaesthetetists' actual care in theatre. 

Aims

Understanding patients’ wishes regarding CPR before surgery is crucial. This study aims to assess the impact of a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision on anaesthetists' actions during theatre.

Methods

We used WhatsApp, to present a scenario of an 83-year-old with ischemic heart disease, cognitive impairment, and an acute hip fracture. Anaesthetists were asked how they would handle various intraoperative events and whether a prior DNACPR decision would influence their actions.

Results

A total of 74 UK anaesthetists, all but one of them consultants, completed the anonymous survey. A surprising number N=27, (37%) of respondents indicated that prior knowledge of a DNACPR decision would have altered their preparedness to anaesthetise the patient.

Despite a pre-existing DNACPR decision N=68 (92%) stated that they would attempt electrical cardioversion if a patient became hypotensive with a regular broad complex tachycardia, as would N=65 (88%) in response to ventricular fibrillation during surgery. N=36 (49%) would initiate chest compressions in theatre if patient failed to respond to electrical cardioversion, but only N=2 (3%) would continue with intubation, ventilation and discussion with critical care if the patient failed to respond to three cycles of compressions and cardioversion.

Conclusion

It is important for anaesthetists to discuss the nuances of different elements of CPR as part of patients’ pre-operative assessment, as it is much more likely to be successful in theatre than in the ward or community settings that most DNACPR discussions will consider.

Raising the topic of resuscitation can lead to anxiety among patients and their families, Our study has shown that most anaesthetists will set aside a DNACPR decision anyway if problems arise in theatre.

Swansea is one of oldest cities by population in the UK (more than 1 in 5 people over 65) leading to an increasing number of frail patients and has a high prevalence of Welsh speakers in the over 65 age group 12% of Swansea Bay employees identify as speaking Welsh.

The Welsh language act awarded equal status to both English and Welsh, encouraging public bodies to publish official documents bilingually.As part of our work in developing frailty screening for elective surgical patients we use the clinical frailty score (CFS) and noted there was not a Welsh language version available. As we are hoping to progress to patients completing the score independently it was clear this was important.

Method

The Bayways Frailty alliance created a version of the CFS in Welsh which followed the same format, was visually appealing and clinically correct. We showed this to both Welsh speaking clinicians of various specialities and allied health professionals; we also shared it with Welsh speaking members of the public who were not clinicians to gain feedback.

Finally we gained approval from Dr Rookwood and his team for this official translation.

Results

There was widespread support for this from both clinicians and non-clinical members of the public. They felt the Welsh was easy to understand and professional. Clinical staff felt empowered that a part of their culture was now part of the workplace.

Conclusion

This valuable piece of work will now be made widely available and encourages changes such as this going forward in keeping with the Welsh Government policies. Alongside that the widespread positive feedback from both clinical staff and patients speaks for itself.