Resuscitation. A matter of life and death.
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Attitude of Health Personnel↗
Biomedical subjects
K Stewart
Publications and source records attributed to K Stewart.
Work in the Chief Medical Examiners Office.
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Alberta↗
Cardiopulmonary resuscitation: doctors and nurses expect too much.
Doctors and nurses in the UK and US have an over-optimistic view of patients' chances of surviving an attempt at cardiopulmonary resuscitation (CPR). If medical staff are to follow the recommendation that they should discuss the pros and cons of CPR with patients and their relatives, they should at least be able to give them realistic expectations of survival; otherwise inappropriate decisions may be made. Resuscitation training programmes should routinely include data on survival from CPR in differing circumstances.
Cardiopulmonary Resuscitation↗
Does audit improve DNR decision making?
The use of 'do not resuscitate' (DNR) orders in hospitals has been the subject of considerable comment in both the medical and the lay press. Guidelines have been produced to help make DNR decisions but, as yet, there have been no published accounts of these in practice. We have used audit to accounts of these in practice. We have used audit to develop DNR policy in our hospital, and have reviewed practice after the introduction of guidelines. This led to early consultant involvement in making decisions in 55 of 80 patients (69%) who were assessed as DNR at the time of death or discharge, documentation of reasons for DNR in all 55 of these and documentation of discussion with nurses in 49 (89%). Consultants agreed with DNR decisions made by their juniors in 31 of 34 cases (91%) and changed 'for CPR' decisions to DNR in 24 of 108 (22%). We have demonstrated that audit is an appropriate way to change and develop practice in sensitive areas such as this.
Adolescent↗
A study of the quality of prescriptions issued in a busy pediatric emergency room.
An analysis of 2,213 prescriptions written by physicians in a busy, urban pediatric emergency room revealed that only 110 or 5 percent had no errors or omissions of specifications. The quality of the prescriptions was evaluated according to the standards of acceptable prescribing for the following specifications: quantity, dosage, time interval between doses or specific hours to be given, and specific instructions. The hospital pharmacists, also under pressure, generally failed to monitor the prescriptions adequately--either they did not rectify the physicians' errors or at times they made incorrect changes. To improve the quality of prescriptions issued under pressure in an emergency room, several courses of action are recommended: Pharmacology departments of medical schools should place more emphasis on teaching students the art of writing explicit, comprehensible prescriptions. The physician and pharmacist should work as a team in the interest of providing patients with accurate and detailed prescriptions; or both the physician and the pharmacist should delegate the composition of prescriptions to an automated computer system, thereby reducing human error in writing and monitoring prescriptions and allowing both professionals more time for direct contact with patients.
Child↗
Resuscitation decisions--when should we talk to patients?
This paper attempts to summarise the results of recent British studies in the area of resuscitation decisions, and to explain the ethical and legal framework for the use of 'do not resuscitate' decisions and to give clear guidance about involving patients and relatives.
Aged↗
When can elderly patients be excluded from discussing resuscitation?
Case notes of elderly medical patients were surveyed to determine when "do not resuscitate' (DNR) decisions could legitimately be made without consulting them. Patients were thought to be suitable for exclusion from decisions if morbidity scores indicated that they were unlikely to survive cardiopulmonary resuscitation (CPR) or if they were mentally incompetent. Thirty per cent of all patients were predicted not to survive CPR; another 28% were deemed incompetent. Of those with DNR decisions, 59% were predicted not to survive and a further 24% were incompetent. Discussing resuscitation would have been appropriate with 17% of those with DNR decisions.
Advance Care Planning↗
Progress toward the elimination of hepatitis B virus transmission among health care workers in the United States.
BACKGROUND: Hepatitis B virus (HBV) infection is a well-recognized occupational risk for health care workers (HCWs). Vaccination coverage, disease trends, and the need for booster doses after hepatitis B vaccination of adults have been the subject of intense study during the 15 years of the vaccine's availability. METHODS: Vaccination coverage of HCWs was determined from a review of medical records on a sample of employees from 113 randomly selected hospitals. The number of HBV infections among HCWs and the general US population for 1983 through 1995 was estimated from national surveillance data. Studies on long-term protection after hepatitis B vaccination of adults were reviewed. RESULTS: A total of 2837 employee medical records were reviewed; 2532 employees (90%) were eligible to receive hepatitis B vaccine, and 66.5% of them (95% confidence interval, 61.9%-70.9%) had received 3 doses of hepatitis B vaccine. Vaccination coverage was highest (75%) for personnel with frequent exposure to infectious body fluids (phlebotomists, laboratory personnel, and nursing staff) and lowest (45%) for employees at low risk for exposure (dietary and clerical staff). The number of HBV infections among HCWs declined from 17,000 in 1983 to 400 in 1995. The 95% decline in incidence observed among HCWs is 1.5-fold greater than the reduction in incidence in the general US population. Studies on long-term protection demonstrate that vaccine-induced protection persists at least 11 years even when titers of antibody to hepatitis B surface antigen decline below detectable levels. CONCLUSIONS: Although a high percentage of HCWs have been fully vaccinated with hepatitis B vaccine, efforts need to be made to improve this coverage. There has been a dramatic decrease in the number of HBV infections among HCWs who are now at lower risk of HBV infection than the general US population. Vaccine-induced protection persists at least 11 years and booster doses are not needed at this time for adults who have responded to vaccination.
Adult↗
Do general practitioners know when living wills are legal?
BACKGROUND: There is growing public awareness of living wills or advance directives. Patients who wish to make advance directives may approach general practitioners (GPs) for advice. However, many GPs are unaware of the correct legal status of living wills. METHODS: Questionnaires were sent to 270 GPs in London and Winchester, asking seven questions about the current legal status of living wills. RESULTS: Of the 214 GPs (79%) who returned questionnaires, only 104 (49%) were aware that some types of advance directives could carry legal force. Many of the GPs who did know that living wills could be legally binding were unable correctly to answer further questions on the practicalities of the law; for example, 26% were wrong in believing that a lawyer had to draw up a living will, and 13% incorrectly believed that a doctor was legally required to give any treatment requested by a patient in a living will. CONCLUSIONS: Half of the GPs surveyed were unaware that living wills currently have legal force and most of the rest were unaware of important details of the law. More attention needs to be given to the education of doctors in this area.
Advance Directives↗