March 8, 2012

Resuscitation status now in electronic record

Resuscitation status now in electronic record

Hospitals use resuscitation status orders to spell out whether measures such as cardiopulmonary resuscitation or tracheal intubation are to be provided in the event of a patient’s sudden or impending cardiopulmonary arrest.

To improve patient care team communication, Vanderbilt University Hospital last week launched electronic documentation and display of resuscitation status orders, also known as code status orders. Resuscitation status is now displayed atop the electronic patient record and in various electronic summary views used by residents and nurses.

“With help from some of our residents we’ve studied this issue and found some opportunities to improve communication of code status,” said Allen Kaiser, M.D., chief of staff of the Vanderbilt Health System. “The new documentation tools, displays and alerts that have been built into our systems will go a long way toward ensuring that each adult inpatient’s code status is properly communicated to the hospital team.”

A revised resuscitation status policy for adult patients, also effective March 1 (policy number CL 30-08.26), clarifies the three options for code status at VUH: Full (full resuscitative measures), DNR (do not resuscitate), and DNR/DNI (do not resuscitate/do not intubate).

To change a patient’s code status, the provider fills out an electronic code status form, which can be retrieved by clicking on the current code status in the medical record. Once the form is completed, an order is automatically generated in the hospital order entry system.

If the form is completed by someone other than the patient’s attending physician — that is, by a resident, nurse practitioner or physician’s assistant — the attending physician must sign it within 48 hours.

Attending physicians are automatically alerted to any unsigned code status orders upon system login.

The systems upgrade was led by Neal Patel, M.D., chief medical information officer for Inpatient Services. Paul Sternberg Jr., M.D., assistant vice chancellor for Adult Health Affairs, oversaw the project. The policy revision process was shepherded by Christine Kennedy, MSN, R.N., administrative director of Inpatient Medicine.

“This new process represents a significant advance in providing the appropriate care desired by our patients and their families. It is the result of a yearlong collaboration across the enterprise including attending physicians from multiple disciplines, house staff, nursing, ethicists, hospital administration and bioinformatics,” Sternberg said.

Leaders of the project stressed that DNR and DNR/DNI status pertain only to resuscitation and should never be misconstrued as “do not treat” orders.

Again, these changes relate to the adult hospital; new tools to support communication of resuscitation status orders for outpatients and for pediatric inpatients are in development.

For more information, see clinical policy CL 30-08.26.