Code status designation: analysis of appropriate documentation, associated patient demographics, and outcomes in the hospitalized patient

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Collazo, Allison Grace
Dale, Orren

Transportable Physician Orders for Patient Preferences (T-POPP) is a POLST (Physician Orders for Life Sustaining Treatment) paradigm medical order form currently being developed as a bi-state initiative. T-POPP allows patients with serious illnesses to permit, limit, or refuse medical interventions. This thesis describes the documentation surrounding current resuscitation status orders for accessibility and clarity in the medical record prior to the regional implementation of T-POPP, in order to better understand at baseline how useful the present system is. Three code status designations are currently in use at KU Hospital relative to cardiac arrest: Full Code (which permits any and all resuscitative efforts); LAR, limited attempts at resuscitation (which permits certain medical interventions and limits others); and DNAR, do not attempt resuscitation (which limits all resuscitative interventions). This study methodology consisted of a systematic review of chart abstractions and reviews for patients with LAR and DNAR instructions in March 2011 from the University of Kansas Hospital. This study explores the prevalence of such orders, how decisions regarding these orders are documented in the medical record for clarity and accessibility, and associated patient demographics. Accessibility and clarity of such documentation is paramount. This study found that there is a high prevalence (96.2%) of documentation regarding code status orders, though significantly lower prevalence of documentation with clarity and accessibility; the highest level of clarity is found in orders with direct quotes and paraphrases; the highest level of accessibility is found in resuscitation status notes and chart notations in the code status order comments section; and that advance directives are not usually available at bedside to provide guidance for plan of care at point of care.

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Thesis (M.S.W.)--Wichita State University, College of Liberal Arts and Sciences, School of Social Work