The impact of language on the interpretation of resuscitation clinical care plans by doctors. A mixed methods study


Autoři: Colette Dignam aff001;  Josephine Thomas aff003;  Margaret Brown aff004;  Campbell H. Thompson aff001
Působiště autorů: Division of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia aff001;  Division of Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia aff002;  Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia aff003;  School of Psychology, Social Work, and Social Policy, Division of Education, Arts and Social Sciences, University of South Australia, Adelaide, South Australia, Australia aff004
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225338

Souhrn

Introduction

Resuscitation clinical care plans (resuscitation plans) are gradually replacing ‘Not for Cardiopulmonary Resuscitation’ orders in the hospital setting. The 7-Step Pathway Resuscitation Plan and Alert form (7-Step form) is one example of a resuscitation plan. Treatment recommendations in resuscitation plans currently lack standardised language, creating potential for misinterpretation and patient harm.

Aims

To explore how terminology used in resuscitation plans is interpreted and applied by clinicians.

Method

A mixed methods study surveyed 50 general medical doctors, who were required to interpret and apply a 7-Step form in three case vignettes and define seven key terms. Statistical analysis on multiple choice and thematic analysis on free-text responses was performed.

Results

Terminology was inconsistently interpreted and inconsistently applied, resulting in clinically significant differences in treatment choices. Three key themes influenced the application of a resuscitation plan: in-depth discussion, precise documentation and personal experience of the bedside deciding doctor.

Discussion

This study highlights persistent communication deficiencies in resuscitation plan documentation and how this may adversely affect patient care; findings unlikely to be unique to Australia or South Australia.

Conclusion

Removing ambiguity by standardising and defining the terminology in resuscitation plans will improve bedside decision-making, while also supporting the rights of the patient to receive appropriate and desired care.

Klíčová slova:

Antibiotics – Cancer treatment – Critical care and emergency medicine – Decision making – Language – Medical doctors – Oxygen – Resuscitation


Zdroje

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Článek vyšel v časopise

PLOS One


2019 Číslo 11