Date of Award
College of Nursing
Sandra L. Spoelstra PhD, RN, FGSA, FAAN
Dianne Slager, DNP, FNP-BC,
Objectives: The quality improvement project objectives were to honor documented Do Not Resuscitate wishes in emergency departments by examining and improving workflow during primary care to emergency department transitions. A location for advance care planning documentations was designated for advanced directives, yet not utilized.
Methods: Mixed method, pre-/post-comparison, and thematic design examined clinicians and patients in a primary care office and two emergency departments in a Midwest healthcare system. Data was collected from patient records, clinician surveys, and observation of workflow. Descriptive statistics, frequency counts and non-parametric tests were used to analyze data.
Results: Patient charts were audited (N=261 [pre=124; post=137]), mean age 79.2 years, 59% female. Clinician surveys included 32 emergency department providers (30=pre; 2=post) and 59 registered nurses (38=pre; 21=post). Patient chart audit (N=137) found 97% had a primary care code status with 2.9% in emergency department records. Provider (mean 2.93) and registered nurse (mean 3.14) moral distress was moderate. Pre/post barriers to discuss advanced directives increased from 80.2% to 100%; comfort discussing advanced directives improved from 43.2% to 100%; and providers (13.3-100%) and registered nurses (3-19%) were more aware of where to document advanced directives.
Conclusions: Gaps in care placed patients with Do Not Resuscitate at risk for harm due to challenges with documentation. Post-implementation knowledge improved yet workflow and placement of Do Not Resuscitate orders in the record did not change. A clinically significant improvement in clinician knowledge of patient safety and location of advance care planning documents may lead to improved care.
Kraus, Emily L., "Honoring Patient Do Not Resuscitate Wishes and Reducing Harm During Transitions of Care: A Quality Improvement Project" (2020). Doctoral Projects. 108.