PT - JOURNAL ARTICLE AU - B Calam AU - R Andrew TI - CPR or DNR? End-of-life decision making on a family practice teaching ward. DP - 2000 Feb 01 TA - Canadian Family Physician PG - 340--346 VI - 46 IP - 2 4099 - http://www.cfp.ca/content/46/2/340.short 4100 - http://www.cfp.ca/content/46/2/340.full SO - Can Fam Physician2000 Feb 01; 46 AB - OBJECTIVE To determine the proportion of patients on a family practice ward who had "code status" orders and end-of-life discussions documented on their charts in the first week of admission. To examine the correlation between a tool predicting the likelihood of benefit from cardiopulmonary resuscitation (CPR) and actual end-of-life decisions made by family physicians and their patients. DESIGN Cross-sectional descriptive study using a retrospective chart review. SETTING A 14-bed teaching ward where family physicians admit and manage their own patients in an urban tertiary care teaching hospital. PARTICIPANTS Patients admitted to the ward for 7 or more days between December 1, 1995, and August 31, 1996. MAIN OUTCOME MEASURES Frequency of documented "do not resuscitate" (DNR) or "full code" orders and documented end-of-life discussions. Prognosis-after-resuscitation (PAR) score. RESULTS In the 103 charts reviewed, code status orders were entered within 7 days for 60 patients (58%); 31 were DNR, and 29 were full code. Discussion of code status was documented in 25% of charts. The PAR score for 40% of patients was higher than 5, indicating they were unlikely to survive to discharge from hospital should they require CPR. There was a significant association between PAR scores done retrospectively and actual code status decisions made by attending family physicians (P < .005). CONCLUSIONS End-of-life discussions and decisions were not fully documented in patients' charts, even though patients were being cared for in hospital by their family physicians. A PAR score obtained during the first week of admission could assist physicians in discussing end-of-life orders with their patients.