Resuscitation status should be reviewed and documented for inpatients with metastatic disease. Consensus resuscitation plans (CRP) reflecting this are underutilised and may lead to inappropriate levels of intervention.
We audited CRP use in oncology inpatients at Box Hill Hospital, where standard of care is CRP completion within 24 hours for patients with metastatic cancer. We aimed to improve education and compliance with CRPs.
Box Hill Hospital oncology patients discharged between Jan-Feb 2017 were identified and their inpatient electronic medical record reviewed noting demographics, CRP and management. If patients had multiple admissions, only the latest admission was considered. Intervention post-audit included education sessions for staff and written prompts. A follow-up audit was conducted on oncology patients discharged May–June 2017.
Pre-intervention: 129 unique patients were identified, 117 with metastatic disease. Of these, 66/117 patients (56%) had a CRP; 48/117 (41%) within 24 hours. 43/66 (65%) patients with CRP had previous CRP. 18 MET calls occurred. 9/18 (50%) had CRP pre-MET this increased to 14/18 (78%) post-MET call.
Post intervention: of 119 unique patients, 104 had metastatic disease. CRP was completed in 75/104 patients (72%) with (59/104) 57% within 24 hours. 33/75 (44%) patients with CRP plan had previous CRP plan. 12 MET calls occurred. 9/12 (67%) had CRP done pre-MET, increasing to 12/12 (100%) post-MET call.
Despite the majority of oncology inpatients having metastatic disease, documentation of CRP is poor. Patients requiring MET calls had high rates of CRP, likely reflecting acuity, and a previous CRP was a predictor for CRP completion during admission. We have demonstrated that in addition to events such as MET calls improving CRP completion rates, compliance can be improved with ongoing education of staff. Alongside ongoing education, further investigation into potential barriers/reluctance for staff to complete CRP on admission is planned.