PB RCPsych Publications
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
British Journal of Psychiatry Advances in Psychiatric Treatment All RCPsych Journals
QUICK SEARCH:   [advanced]


     

Psychiatric Bulletin (2007) 31: 110. doi: 10.1192/pb.31.3.110b
© 2007 The Royal College of Psychiatrists
This Article
Right arrow Full Text (PDF)
Right arrow Submit an eLetter
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hawkins, Z.
Right arrow Articles by Upadhyaya, A.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Hawkins, Z.
Right arrow Articles by Upadhyaya, A.

Correspondence

‘Do not resuscitate’ decisions – need for objective measures

Zoë Hawkins, Senior House Officer in Psychiatry and Ajay Upadhyaya, Consultant Psychiatrist

Herts and Essex Hospital, Cavell Drive, Bishop’s Stortford, Herts CM23 5JH, email: frances.stride{at}hpt.nhs.uk

We recently conducted an audit of the documentation of cardiopulmonary resuscitation (CPR) status in patients on a 20-bed dementia assessment ward (all with a diagnosis of dementia and lacking mental capacity to discuss resuscitation) and found that only a quarter had their CPR status documented. Following discussions with staff to draw their attention to trust policy on CPR, re-audit showed only modest improvement: CPR status was documented in half of the patients’ notes. An educational programme was arranged to address the potential barriers to optimal CPR documentation. Subsequent audit showed documentation of CPR status in three-quarters of patients.

Poor quality of life and futility of CPR are often cited as the reasons behind the decision not to resuscitate. Despite the advanced age and diagnosis of dementia in our patients, judgements on patients’ quality of life can be complex and emotive, and the critical factor seemed to be a lack of readiness among staff to initiate discussion of issues surrounding death.

We agree that relatives should be involved in discussions on resuscitation. However, this has to be done with sensitivity so that a decision not to resuscitate does not add to the relatives’ sense of guilt. Often this can be achieved by presenting such decisions as a considered opinion of the team before seeking the relatives’ view.





This Article
Right arrow Full Text (PDF)
Right arrow Submit an eLetter
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hawkins, Z.
Right arrow Articles by Upadhyaya, A.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Hawkins, Z.
Right arrow Articles by Upadhyaya, A.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
British Journal of Psychiatry Advances in Psychiatric Treatment All RCPsych Journals