Standardization of inpatient CPR status discussions and documentation within the division of hematology-oncology at UPMC Shadyside: Results from PDSA cycle 1 and 2.

Authors

Christine Garcia

Christine Ann Garcia

Stony Brook University Hospital, Port Jefferson, NY

Christine Ann Garcia, Mamta Bhatnagar, Rachel Rodenbach, Edward Chu, Stanley M. Marks, Abigail Graham-Pardus, Jamie Kriner, Melissa Winfield, Christopher Minnier, Janet Leahy, Sharon Hanchett, Emily Baird, Joshua Levenson

Organizations

Stony Brook University Hospital, Port Jefferson, NY, UPMC, Pittsburgh, PA, University of Pittsburgh Medical Center, Pittsburgh, PA, UPMC Hillman Cancer Center, Pittsburgh, PA, UPMC Magee-Womens Hospital, Pittsburgh, PA, UPMC Heart and Vascular Institute, Pittsburgh, PA

Research Funding

Other

Background: In December 2016, 49% of patients admitted to inpatient oncology services at UPMC Shadyside had CPR status discussion documentation prior to discharge. This project aims to improve quality and rates of CPR status conversations. Methods: During Plan-Do-Study-Act (PDSA) cycle 1, a stakeholder workgroup was formed in January 2017 by oncology faculty, fellows, nurses and advance practice providers (APPs), medicine house staff, and palliative care faculty. All oncology clinicians were reminded weekly to discuss and document CPR status preferences. APPs received communication training with palliative care specialists. Oncology leadership received a monthly update of CPR status documentation rates, and endorsed CPR status best practice guidelines developed by the workgroup. For PDSA cycle 2, patient charts without CPR status documentation in March 2018 were reviewed. Results: PDSA cycle 1 resulted in CPR status assessment rates increasing from 49% to > 80%. 1400+ more CPR status discussions were documented in 2017 than 2016. The percentage of patients discharged “Comfort Measures Only” or “Do Not Resuscitate” increased from 14.2 (S.D. 2.4) to 20.0 (S.D. 2.1). For PDSA cycle 2, 60 patients without CPR assessment were reviewed. Fifty-two percent were admitted overnight by nocturnists, 48% by daytime APPs, and none by housestaff. 55% (33/60) had metastatic disease. Fifty-three percent (31/60) of patients had prior CPR status documentation in the past 12 months. Fifteen percent (11/60) of patients were admitted for scheduled inpatient chemotherapy. Conclusions: PDSA 1 showed that standardization of CPR status assessment with formal training increased CPR status assessments. More patients wanted CMO or DNR when asked, which may indicate the need for earlier goals of care discussions. PDSA 2 indicated that focusing efforts on completing CPR assessment as part of the admission process, especially for scheduled inpatient chemotherapy admissions, is critical in further improving our rates.

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Abstract Details

Meeting

2018 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session B: Projects Relating to Patient Experience; Projects Relating to Safety; Technology and Innovation in Quality of Care

Track

Projects Relating to Patient Experience,Projects Relating to Safety,Technology and Innovation in Quality of Care

Sub Track

Standardization Efforts to Improve Safety

Citation

J Clin Oncol 36, 2018 (suppl 30; abstr 257)

DOI

10.1200/JCO.2018.36.30_suppl.257

Abstract #

257

Poster Bd #

K1

Abstract Disclosures

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