'Do Not Attempt Resuscitation' - Do Standardised Order Forms make a clinical difference above hand-written note entries?

SummaryAimTo quantify any effect of Standardised Order Forms (SOFs), versus hand-written note entries for 'Do Not Attempt Resuscitation' - on the selection and survival of remaining cardiopulmonary resuscitation (CPR) attempts.MethodsA prospective, observational study in two UK Hospitals, comparing numbers, demographics and survival rates from CPR attempts for 2 years prior to and 2 years after the introduction of SOFs (the only change in DNAR policy).ResultsThere were 133 CPR attempts, representing 0.30% of the 44,792 admissions, pre SOFs and 147 CPR attempts representing 0.32% of the 45,340 admissions following the SOFs (p = 0.46). The median duration of a CPR attempt was 11 min prior to and 15 min following the SOFs (p = 0.02). Of the CPR attempts, there was no change in mean age (p = 0.34), proportions occurring outside working hours (p = 0.70) or proportions presenting with an initial shockable rhythm (p = 0.30). Survival to discharge following CPR was unchanged (p = 0.23).ConclusionsThe introduction of SOFs for DNAR orders was associated with a significantly longer duration of CPR (on average by 3-4 min) but no difference in overall number, demographics or type of arrest or survival in the remaining CPR attempts.