Comparison of not for resuscitation (NFR) forms across five Victorian health services

Levinson, M., Mills, A., Hutchinson, A. M., Heriot, G., Stephenson, G. and Gellie, A. 2014, Comparison of not for resuscitation (NFR) forms across five Victorian health services, Internal medicine journal, vol. 44, no. 7, pp. 671-675.

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Title Comparison of not for resuscitation (NFR) forms across five Victorian health services
Author(s) Levinson, M.
Mills, A.
Hutchinson, A. M.ORCID iD for Hutchinson, A. M.
Heriot, G.
Stephenson, G.
Gellie, A.
Journal name Internal medicine journal
Volume number 44
Issue number 7
Start page 671
End page 675
Total pages 5
Publisher Wiley-Blackwell
Place of publication Richmond, Vic.
Publication date 2014-07
ISSN 1444-0903
Keyword(s) resuscitation order
hospital communication system
cardiopulmonary resuscitation
withholding treatment
Summary Background
Within Australian hospitals, cardiac and respiratory arrests result in a resuscitation attempt unless the patient is documented as not for resuscitation.

To examine the consistency of policies and documentation for withholding in-hospital resuscitation across health services.

An observational, qualitative review of hospital policy and documentation was conducted in June 2013 in three public and two private sector hospitals in metropolitan Melbourne. Not for resuscitation (NFR) forms were evaluated for physical characteristics, content, authorisation and decision-making. Hospital policies were coded for alerts, definition of futility and burden of treatment and management of discussions and dissent.

There was a lack of standardisation, with each site using its own unique NFR form and accompanying site-specific policies. Differences were found in who could authorise the decision, what was included on the form, the role of patients and families, and how discussions were managed and dissent resolved. Futility and burden of treatment were not defined independently. These inconsistencies across sites contribute to a lack of clarity regarding the decision to withhold resuscitation, and have implications for staff employed across multiple hospitals.

NFR forms should be reviewed and standardised so as to be clear, uniform and consistent with the legislative framework. We propose a two-stage process of documentation. Stage 1 facilitates discussion of patient-specific goals of care and consideration of limitations of treatment. Stage 2 serves to communicate a NFR order. Decisions to withhold resuscitation are inherently complex but could be aided by separating the decision-making process from the communication of the decision, resulting in improved end-of-life care.
Language eng
Field of Research 111001 Aged Care Nursing
111709 Health Care Administration
110305 Emergency Medicine
Socio Economic Objective 920208 Health Policy Evaluation
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2014, Wiley-Blackwell
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