Code Status Discussion Educational Product

MedEdPORTAL

Shaida Brandon¹ 

[1] 1 University of Utah School of Medicine;

关键词: CPR;    Cardiopulmonary Resuscitation;    Code Status;    DNR;    Do-Not-Resuscitate Orders;    Goals of Care;   

DOI  :  10.15766/mep_2374-8265.9442

来源: DOAJ

【 摘 要 】

Abstract Introduction Conducting a goals-of-care discussion regarding code status is a complex skill requiring a balanced approach to sharing information in a succinct yet empathic manner. Unfortunately, health care professionals receive little to no training in conducting these vital discussions. Studies have found that the median length of the code status discussion is 10 minutes when conducted by residents and only 1 minute when conducted by attending hospitalist physicians. Recommendations supported by professional organizations state that cardiopulmonary resuscitation (CPR) discussions should cover several specific elements: ensuring that patients understand their prognosis; eliciting values and goals for care; explaining the nature of CPR and its risks, benefits, and possible outcomes; and making a recommendation about CPR that is consistent with the patient's prognosis and goals for care. Methods This competency-based interactive training experience educates participants regarding the components of an effective code status discussion and improves their skills in conducting these critical discussions. The program highlights studies describing the efficacy of CPR in a variety of clinical settings, offers an efficient and effective outline for code status discussions, affords participants an opportunity to examine how they currently conduct these discussions, and provides carefully devised examples of phrases participants can use to give patients information to facilitate informed decision making about code status. The training session lasts from 1.5 to 2 hours. Results The presentation has been well received in small groups and in large conference settings. It was one of the highest-rated presentations at the Utah State Advance Care Planning and POLST Conference, which was attended by over 50 health professionals representing numerous disciplines. The educational session has also been shared in small groups with internal medicine interns (N = 39) at the University of Utah during their 2011–2012 geriatrics rotation. Seventeen interns completed a voluntary, confidential, pre- and postexperience survey assessing their self-efficacy regarding code status via a 5-point Likert scale (1= strongly disagree, 5 = strongly agree). Prior to the educational session, interns had a neutral response to “I feel comfortable conducting a code status discussion” (mean score = 3.18, SD = 1.07); after the educational session, interns' scores for the same statement improved to 4.59 (SD = 0.50). Discussion I am currently working on a videotaped adaptation of the code status discussion. In this adaptation, participants will watch clips of actors discussing code status utilizing the informed consent discussion model. A live facilitator will pause the video at prescribed times to lead participants in discussion.

【 授权许可】

Unknown