Introduction:
Evidence is mounting that appropriate family presence during resuscitation (FPDR) can be beneficial to patients and their families including lower rates of post-traumatic stress disorder after the event. Despite this, FPDR has not been widely adapted and continues to have legitimate barriers. Therefore, the focus of this quality improvement project was to conduct an organizational needs assessment at Duke University to create a systematic FPDR guideline that can be consistently implemented across the hospital.
Methods:
A 17-question survey tool was created using Ottowa Decision Making Framework and distributed to all members of a Cardiothoracic Intensive Care Unit code team including physicians, advanced practice providers, nurses, respiratory therapists, chaplains, perfusionists, pharmacists and social workers. The questions addressed FPDR experience, decision making influencers, situational comfort, and demographics.
Results:
There was a total of 200 responses. 46.6% Registered Nurses, 7.3% were Advanced Practice Providers, 7.8% Attending Physician, 6.2% Resident Physicians, 19.2% Respiratory therapists, 2.5% Chaplains. Four themes emerged - comfort based on experience, support for early chaplain involvement, need of family facilitator role, and absolute resistance. Multiple concerns were raised by the surveyed healthcare providers including logistics, risk for legal retribution, distraction from resuscitation, family suffering, and ill preparedness regarding FPDR. 72% of the respondents endorsed utilizing a family facilitator role to support the practice of FPDR. There was wariness regarding using the term ‘protocol’ for the guideline document.
Conclusions:
There are varying levels of comfort and support regarding the practice of FPDR amongst the resuscitation team. Many healthcare professionals acknowledge a need for family facilitation with a dedicated staff member, while others respond with a resolute unwillingness to practice FPDR. There is a need for education and publication of guidelines to assist staff in gaining consistency and confidence in the practice of FPDR.
