1237 An age-old issue: interpretive qualitative study at major tertiary hospital understanding challenges to NFR implementation

<h3>Background</h3> In New South Wales the ‘Using Resuscitation Plans in End-of-Life Decisions’ policy provides guidance for medical officers on when CPR can be withheld if it confers no benefit to the patient. Despite this, elderly, frail patients with multiple comorbidities where CPR would not be of benefit are experiencing resuscitation attempts during an acute admission. <h3>Aim</h3> We are seeking to understand the medical and nursing staff perspectives of NFR orders and identify potential barriers to implementation at a major tertiary hospital in Sydney. <h3>Methods</h3> Interpretive qualitative research design was used, with semi structured in depth interviews of 15 medical officers and 15 nurses. Interviews were analysed drawing on Braun and Clarkes thematic analysis. <h3>Findings</h3> Three Core Themes were Identified: Challenges in making the decision – Conflict when more than one medical teams involved; avoidance of discussions after hours; vulnerability of medical registrars and nurses escalating to consultants; family involvement in decision-making; differences in private and public patients. Lack of Clarity – contrasting policies for both nursing and medical staff of when NFR orders could be implemented; significant variation in language and terminology discussing NFR orders; differing beliefs when they should be implemented for patients; perception that family must be involved. No structured approach to education – lack of ongoing education for both nursing and medical officers within the hospital. <h3>Discussion</h3> These results have identified that there is a lack of education for nursing and medical officers regarding medically instigated NFR orders and decision-making discussions and the relative policies in NSW. There is a hesitance for Advanced Trainees to escalate to senior medical officers due to a vulnerability of junior staff. Nursing staff feel when they raise legitimate concerns about NFRs with medical teams, these are not taken under consideration. <h3>Unique Contribution</h3> This study included a broad range of surgical and medical specialties’ perspectives providing great insight into the current culture of NFR decision-making. This study has identified a variety of barriers that would not only be isolated to our facility but to those across NSW. <h3>Implications</h3> If these barriers are not addressed, non-beneficial CPR will continue to be delivered to patients, leading to traumatic, undignified deaths and poor end-of-life care. If we do not change the culture and ensure the psychological safety of our workforce as well as deliver the required education, there will be an ongoing burden of non-beneficial interventions, lengthy ICU stays and costs to the healthcare system.