DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
Is there a valid 'Do not attempt cardiopulmonary resuscitation' (DNACPR) document or decision written in patient's medical record?
If not, CPR is mandatory when any person suffers a cardiorespiratory arrest
RECOGNITION
- Anticipate the likelihood of cardiopulmonary arrest
- if CPR may be inappropriate, discuss DNACPR status with patient
- DNACPR order applies solely to cardiopulmonary resuscitation and does not affect any other aspect of treatment
Patient admitted with community DNACPR order
- Review DNACPR status as soon as is clinically possible
- Community DNACPR remains valid until a consultant review is completed
Clinical justification
- Prolonging a patient's life usually provides a health benefit to that patient
- A DNACPR order is ‘in the best interests of the patient' if one or more of the following applies:
- patient is irreversibly close to death
- despite successful CPR, there would be an unacceptably high probability of death or severe brain damage
- length and quality of life after resuscitation are unlikely to be valued by patient
- patient, who is mentally competent, has expressed consistent desire not to be resuscitated
Ethics and consent
- DNACPR is a clinical decision. It does require consent
- Complete Capacity assessment on ReSPECT form
- if mentally competent, discuss DNACPR status with patient
- if patient lacks capacity, discuss with others involved in the care and welfare of the patient if available
- in an emergency, document but discuss ASAP
Documentation
- Document decision-making process at the time it happens on the ReSPECT form and in detail in the medical notes
- Once decision made, doctor (SpR or above) documents on the ReSPECT form document
- Once decision made, most senior nurse present must:
- write ‘not for cardiopulmonary resuscitation' prominently in nursing record
- sign entry and write name and post in capitals
- Senior doctor and nurse inform the ward team
SUBSEQUENT MANAGEMENT
Review
- Doctor reviewing the DNACPR order documents and dates the review on the ReSPECT document and in the medical record
DNACPR decision rescinded
- The decision must be written prominently in the medical notes by the doctor making the decision
- If the ReSPECT form is cancelled, cross through with two diagonal lines in black ball-point ink and the word 'CANCELLED' written clearly between them
- date and print name and GMC/NMC number clearly underneath your signature to validate
- Senior nurse updates the nursing records and informs all other members of the healthcare team of the change in status
DISCHARGE
- If patient discharged from hospital with active DNACPR order, advise:
- the patient/carers to keep the document in a safe and visible place that carers, family and friends are aware of to ensure this is accessible in the event of an emergency
- the patient's GP is informed of the DNACPR via the discharge letter