Background: Many patients and their surrogates have a poor understanding of the process of cardiopulmonary resuscitation (CPR), its limitations, and its complications. Lack of knowledge about CPR may lead patients to choose a code status that does not align with their goals and values. Studies have shown that showing patients an educational video about code status has significantly improved knowledge about CPR and significantly increased the number of patients opting for do-not-resuscitate (DNR) orders.
Purpose: Physicians at an urban teaching hospital created an eight-minute educational video about code status. We piloted the video in the critical care/progressive care unit for patients who were greater than 85 years old, suffered from life threatening illness and/or multiple chronic illnesses, had multiple readmissions, or prolonged hospitalization. The goal of the project was to evaluate the process flowchart for areas of improvement and to evaluate whether this video improved patient knowledge about CPR.
Description: The pilot was conducted over the course of four months. The planned workflow was as follows: 1) the physician or nurse caring for a patient who met the above criteria placed an order for the code status educational video, 2) the nurse administered a survey prior to showing the video, played the code status video, and administered the same survey after the patient had viewed the video. The survey contained five validated questions used to assess patient knowledge about CPR. Eighteen patients participated; data from four patients was excluded because the surveys were incorrectly completed. Of the 14 patients who correctly filled out the surveys, their scores on average improved 1.9 points (out of 5 possible points). Regular implementation of the code status video was limited due to physicians’ time constraints and nurses’ discomfort with showing a code status video.
Conclusions: Multiple studies have demonstrated that education videos about code status improve patients’ and families’ knowledge about code status and enhance a meaningful conversation with their provider. Integrating code status videos into the hospital workflow outside of a controlled study setting will require further exploration. RN discomfort with the initiation of a video without specific introduction by a provider may be a limiting factor if not addressed going forward.