Documentation and communication of code status, specifically do not resuscitate (DNR) status, are important in many facets of healthcare. Like other settings, outpatient oncology is lacking consistency related to documentation and communication of code status. This inconsistency can lead to stressful scenarios for patients, families, and clinical staff in the event of a code. The focus of the scholarly project was to create a nursing process that would eliminate uncertainty surrounding a patient’s documented code status. The project took place in a rural, hospital-based, outpatient oncology/hematology/infusion center. The evidence-based practice quality improvement project was tailored around the clinical question, “Would implementing a visual aid system to flag patients who have DNR documentation within their electronic chart at the project site increase staff awarenes of patients who have DNR status in place?” Richard Ryan and Edward Deci’s Self Determination Theory was chosen as the guiding theory for the project, while Ian Graham’s Knowledge in Action Model acted as the guiding evidence-based practice framework. Rocky Mountain University of Health Professional’s Institutional Review Board deemed the project “not research.” Three objectives informed the scholarly project. The first objective implemented a nursing workflow process and physical visual aid system for staff to recognize easily patients who have DNR wishes in their electronic oncology record. The second objectives included increasing staff awareness when a patient was being cared for who had a DNR document on file. The final objective ensured zero resuscitations occurred on patients who had DNR wishes on file. Nursing included the project processes as a part of their daily workflow. Data was collected over a period of six weeks and later evaluated using the Chi-square analysis. Of 29 possible clinic days during the project, the nursing flowsheet and DNR flagging system was completed 27 to 93.1% of the time. Over six weeks, 42 incidences of patients with DNR on file within the site’s electronic record were found; these incidences were flagged 42 or 100% of the time. Further, of 24 days available for staff to include DNR status in a daily huddle, staff documented including the status 22 or 96% of the time. The project improved communication of important patient wishes equating to a safer environment for both patients and staff. We recommend the project is completed in a larger setting where staff and patients are more demographically diverse to increase transferability. Recommendations further include end of life or code status documents within a hospital and its clinic system be included as they might yield additional information on this topic.
