PMID: 8961119Dec 1, 1996Paper

Do the ward notes reflect the quality of end-of-life care?

Journal of Medical Ethics
Daniel P SulmasyE Marx

Abstract

To study the accuracy of reviewing ward notes (chart review) as a measure of the quality of care rendered to patients with "Do Not Resuscitate" (DNR) orders. We reviewed the charts of 19 consecutive, competent inpatients with DNR orders for evidence that the staff addressed a broad range of patient care needs called Concurrent Care Concerns (CCCs), such as withholding treatments other than resuscitation itself, and attention to patient comfort needs. We then interviewed the patient, consultant physician, house officer, and primary nurse and compared the ward notes with the understandings of these staff members. The medical service of an urban university medical centre. The average number of documented CCCs addressed per DNR order was 1.1. The ward notes generally agreed with the perceptions of patients, house officers, and nurses (% agreement with notes = 79%, 77%, and 82%; kappa = 0.43, 0.40, 0.50). Consultant physicians' understandings were poorly reflected in the ward notes (% agreement = 59%; kappa = 0.18). They overestimated attention to CCCs compared with the notes (P < 0.0001) and with other observers (P < 0.0001). Chart review for attention to CCCs accurately reflects the understandings of patients, house officers, and ...Continue Reading

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Citations

Dec 29, 2000·Journal of Pain and Symptom Management·J J FinsC A Acres
Feb 20, 2008·Palliative & Supportive Care·Catherine M HandyWayne A Ury
Mar 10, 2001·Journal of Evaluation in Clinical Practice·P H GompertzM G Pearson
Sep 13, 2006·Journal of General Internal Medicine·Daniel P SulmasyWayne A Ury
May 29, 2007·Journal of Pain and Symptom Management·Gerhild BeckerHubert E Blum
Aug 1, 2006·Journal of Pain and Symptom Management·Amy S KelleyJoseph J Fins
Feb 26, 2015·Resuscitation·Yuri ShifKhalid F Almoosa
Jun 28, 2003·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Neal J MeropolKevin A Schulman
May 31, 2017·Journal of Clinical Nursing·Intima AlrimawiAbdul-Monim Batiha
Mar 1, 2005·Environmental Health and Preventive Medicine·Miyuki TakanoAtsushi Ueda

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