부산대학교 도서관

1. Identify EHR advancements that can mitigate barriers to creating a peri-procedural code status workflow that aligns with established quality standards. 2. Define a feasible interdisciplinary model for managing peri-procedural code status orders. Many institutions do not have a standardized workflow to manage peri-procedural inpatient DNAR orders likely at least partially owing to the complexities involved. We successfully created a feasible and reproducible interdisciplinary team process with EHR modifications to address this important safety issue in our university hospital. Despite guidelines from multiple national societies and broad consensus that Do Not Attempt Resuscitation (DNAR) orders should be addressed prior to surgeries and procedures, numerous studies have demonstrated that there are gaps in achieving this standard. Many institutions do not have a system to manage peri-procedural code status orders, likely at least partially related to the complexities of creating a process that is clinically feasible in complex institutions. Our aim was to develop a feasibility pilot to design and implement an interdisciplinary process supported by the EHR for temporarily rescinding inpatient DNAR code status orders for cardiology procedures in our university hospital setting. Through collaboration with cardiology nursing leadership and IT analysts, a workflow was developed where physicians place 'signed and held' orders that nursing can manage and release when appropriate. This process was piloted in cardiology electrophysiology and cardiac catheterization procedural areas and process measures were tracked. 13 DNAR inpatients (3 ICU) with an average age of 76 years underwent 17 procedures in a 6 week period. The entire protocol was followed for 11/17 procedures, orders were changed for 13/17 procedures and there was clinician documentation regarding code status management for 14/17 procedures. Given perceived success of the process by the cardiology team, cardiology leadership elected to apply the new workflow to transesophageal echo procedures. Based on this pilot, it is feasible to create a work flow for periprocedural code status management in cardiology. Interdisciplinary team collaboration including IT support was beneficial to creating and implementing our pilot. Fidelity to quality standards for procedural management of patients with code status limitations can be achieved. However, we anticipate complexities and challenges with dissemination to other procedural environments and specialties. Surgical / Palliative Care Models of Palliative Care Delivery [ABSTRACT FROM AUTHOR]