Mrs Grace Edwards1, Mr Douglas Billing1,2, Ms Georgina Learmonth1,2, Professor Kate White1,2,3
1Sydney Local Health District, Camperdown, Australia, 2University of Sydney, Camperdown, Australia, 3Daffodil Centre, Camperdown, Australia
Biography:
Grace Edwards is the End-of-Life Care Coordinator at SLHD, with extensive experience in acute care, clinical education, and service development. She leads initiatives to improve compassionate, culturally responsive care, advance care planning, and consumer engagement. Grace is currently involved in research on Kennedy Terminal Ulcers, Not-for-Resuscitation policy reviews, and evaluating the quality of end-of-life care in acute settings. She has presented on calciphylaxis, JMO ACP education initiatives and quality end of life care in the acute care setting. Grace is passionate about improving death literacy across consumers and clinicians, building workforce capability and embedding public health approaches into palliative care.
Abstract:
Background:
Not For Resuscitation (NFR) policies provide guidance for clinicians on not commencing CPR on medical grounds when there would be no or negligible benefit to the patient or when CPR risks unnecessary harm. While undertaking research to understand the barriers to NFR discussions and implementation at our tertiary facility, a difference in the knowledge and understanding of NFR policies separate to Advance Care Planning (ACP) was identified. Among medical and nursing professionals there was either limited awareness of NFR policies or a lack of clarity of when it could be enacted.
Aim:
To undertake a document review of State and Local Health District (LHD) policies on ACP and NFR orders to understand the similarities and differences.
Method:
A comparative review was conducted of state and LHD policy documents from inpatient facilities in NSW that discuss NFR documentation.
Results:
Of the 98 documents reviewed, 49 (50%) met inclusion criteria. Only 29% documents referenced the NSW Health directive. ACP was defined in 53% documents, ACD in 48%, and Resuscitation Plan in 32%, of which 12 aligned with the state policy definition. Significant variation was observed in terminology and abbreviations among all documents.
Conclusion:
There is a clear lack of consistent policy surrounding the use of NFR orders across NSW Health facilities as a single standalone document. This is significant as there continues to be a misunderstanding amongst both nursing and medical staff of the clinical scenarios that an NFR order could or should be implemented. This leads to non-beneficial CPR being provided causing increased trauma to patients, their families as well as staff. This is a significant finding as medical staff rotate every 3-6 months between hospitals across NSW. Successful ACP and NFR discussions and implementation are reliant on medical staffs’ knowledge and understanding of policies and where to access them.