1238 What’s the difference and the impact? Review of NFR policy and documentation across NSW health

<h3>Background</h3> Not For Resuscitation (NFR) policies provide guidance for clinicians to not commence CPR on medical grounds that it would be of no benefit to the patient or risks unnecessary harm. While undertaking research to understand the barriers to NFR discussions and implementation at our tertiary facility, a difference in knowledge of and understanding of NFR policies separate to Advanced Care Planning (ACP) was identified. Among medical and nursing health professionals there was either limited awareness of NFR policy or a lack of clarity of when it could be enacted. <h3>Aim</h3> We have undertaken a document review of State and Local Health District (LHD) policies on ACP and NFR orders to understand the variations that exist. <h3>Method</h3> We conducted a comparative review of policy and guideline documents from hospitals in NSW that outline the use of NFR documentation for inpatients. <h3>Results</h3> A variation of policies and guidelines have been implemented across NSW Health, with a majority utilising the NSW Health ‘Using Resuscitation Forms in End-of-Life Decisions’ policy. Most facilities do not have a specific standalone document to guide clinicians however some do include this in their ACP or deteriorating patient policies. <h3>Discussion</h3> There is a clear lack of consistent policy surrounding the use of NFR orders across NSW Health facilities as a single standalone document. This is significant as there continues to be a misunderstanding amongst both nursing and medical staff of the clinical scenarios that an NFR order could or should be implemented leading to non-beneficial CPR being provided causing increased trauma to patients, their families as well as staff. <h3>Significance</h3> This is a significant finding as medical staff rotate every 3–6 months between hospitals across NSW and are exposed to differing practices and processes for NFRs. Successful ACP and NFR discussions and implementation are reliant on medical staffs’ knowledge and understanding of policies and where to access them. <h3>Unique Contribution</h3> We have identified a lack of clarity and potential for confusion that may impact patient care due to implementation of policies regarding NFR orders and how they should be utilised in accordance with legislation surrounding withholding of non-beneficial interventions. We propose development of a state-wide policy specific to the utilisation of resuscitation orders outlining the clinical scenarios in which they can and should be utilised.