Background At Medway Foundation Trust, an audit reviewing resuscitation decision-making revealed we had to be more decisive with our DNACPR orders. This led to the introduction of Treatment Escalation Plan (TEP) forms. TEP forms ensure that every patient has their ceiling of care discussed and documented formally.

Aim Our aim was to improve TEP documentation through developing a revised and concise form through our TEP working group of consultants.

Methods Plan-do-study-act (PDSA) cycles (100 patients per cycle across both medical and surgical wards) were carried out over a two-year period to evaluate whether TEP forms had been effective at improving escalation planning and DNACPR decision-making.

Results An improvement of 14% was seen with appropriate TEP form completion after the introduction of the revised TEP form. 75% of the forms were completed within 24 hours of admission, compared to 68% with the initial TEP form. There was a 16% increase in patient/relative discussion. In addition, there was a 13% improvement in resuscitation decision-making since the introduction of TEP forms and increased staff awareness surrounding patient’s escalation plan.

Conclusion The revised TEP form led to fewer errors and an increase in documentation. The higher completion rates and increased clarity among staff have helped improve patient safety outcomes and communication between patients and staff members. However, we have still not yet reached our target of 100% TEP form completion within 24 hours. Our results demonstrated that many patients/relatives are not being included in these discussions and complaints were highlighted regarding inappropriate treatment escalation and resuscitation. These results have allowed us to develop interventions to combat these issues identified. A patient focused information leaflet and staff mandatory intranet training resource are currently in development, the impact will further be assessed in a further PDSA cycle.