Journal of the Royal College of Physicians of London
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J R Coll Physicians Lond · Apr 1993
Professional attitudes to cardiopulmonary resuscitation in departments of geriatric and general medicine.
Cardiopulmonary resuscitation for the elderly has long been a contentious issue. We have established by means of a postal survey the attitudes of 300 consultant geriatricians, 300 consultant physicians and 249 registered nurses to cardiopulmonary resuscitation. We also audited 400 case notes to document current practice in departments of general medicine and medicine for the elderly. ⋯ Case note audit revealed that geriatricians were better at documenting resuscitation decisions. Inappropriate resuscitation of patients is unacceptable. Each department or hospital ought to have agreed guidelines for cardiopulmonary resuscitation.
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The use of 'do not resuscitate' (DNR) orders is widespread in UK hospitals, but until recently there has been no formal policy for this practice. The decision not to resuscitate should be made on ethical and medical grounds. The ethical implications for such decisions are explored. ⋯ There have been failures of communication between doctors and nurses, and between consultants and their juniors. These issues have now come to public and professional attention. There is a need for coherent national and local resuscitation policies that should take into account the medical, ethical and practical aspects of DNR decision making.
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J R Coll Physicians Lond · Apr 1993
The 'do not resuscitate' decision: guidelines for policy in the adult.
The Royal College of Physicians of London, along with a number of organisations, has considered the policy for 'do not resuscitate' (DNR) orders in relation to cardiopulmonary resuscitation (CPR). On the basis of current attitudes towards the more active involvement of patients in such decisions--advance directives (living wills)--and the usual approach in the UK of seeking the views of relatives or next of kin, general guidelines have been drawn up which take into account the results obtained with CPR. The guidelines encompass only the broad principles, as it is envisaged that each hospital or unit will require a more detailed policy according to local circumstances and facilities. Children have not been included because of the special considerations that relate to neonatal resuscitation and the consents required.
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One explanation for the well documented poor basic resuscitation skills of health-care professionals is that these skills are not acquired during initial training. The first aim of our study was to assess the basic life-support skills of trainers teaching basic resuscitation. The second aim was to examine the relationship between the trainers' confidence and actual skill. ⋯ Assessments before and after the course showed significant positive correlation between confidence at performing basic life-support and actual skill. There is an urgent need for formal instructor training in the UK. The training programme should be evaluated, as should the performance of both trainers and trainees, to ensure that all have acquired the requisite skills.