CODE: a practical framework for advancing patient-centred code status discussions

Petersen, Alec; Tulsky, James A.; Mendu, Mallika L.

doi:10.1136/bmjqs-2019-010791

Cited by 5 publications

(1 citation statement)

References 16 publications

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“…The elements of this “CODE” framework are: (C) Choice simplification, (O) Order entry standardization, (D) Don’t delay discussions, and (E) Educate the workforce. 13 At our institution, a task force composed of anesthesiologists, surgeons, quality and safety committee members, and palliative care specialists was developed for addressing the proven inconsistency of CSDs in our perioperative DNR/DNI population. The “CODE” framework was followed to strategize and implement improved processes.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Code Status Discussions: How Are We Doing?

et al. 2021

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Approximately 15% of patients with a code status of do-not-resuscitate (DNR) or do-not-intubate (DNI) present for surgery. Despite professional guidelines requiring discussions with patients regarding perioperative resuscitation, it is unclear whether these recommendations are consistently followed. Our review of 158 patient encounters with established DNR/DNI code status found that code status discussions (CSDs) were documented only 70% of the time, and code status orders were inconsistently entered to reflect those discussions. We present solutions to improve CSD documentation, including refining perioperative workflows, simplifying code status choices, optimizing electronic health record order entry, and a supplementary consent form to facilitate code status review.

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Section: Discussionmentioning

confidence: 99%