Do Not Attempt Resuscitation (DNAR) Policy - Dudley Primary Care ...

Review
Review 1 Review 2
Clinician Name: Clinician Name:
Designation: Designation:
Date reviewed: Date reviewed:
Date for Review: Date for Review:
Signature: Signature:
This space can be used for any general statement of wishes including
preferred place of care. If a formal Advance Decision Refusing
Treatment is required the Patient is advised to use a separate document.
Notes on completion of the form:
1. Giving this information enables WMAS to call this relative, friend or professional for
support after they have left the patient’s address.
2. The patients GP, Consultant or senior nurse can sign as first signatory. However the GP
or Consultant MUST sign as the second signatory (as soon as possible) if the senior
nurse is the first signatory. In complex situations or when there is disagreement about a
DNAR decision it is recommended as best practice to have 2 signatories from clinicians
who know the patient.
3. Notifying WMAS of the existence of this form will allow Emergency Clinicians the
knowledge of this DNACPR – Please fax details (see enclosed form) to the SPA Hub
4. Notifying WMAS will facilitate the uploading of details onto the WMAS computer (CAD)
system. Although the form is still valid without this communication, this is important
information for WMAS. Make sure the form itself stays with the patient
5. The clinician completing the DNACPR should ensure that all relevant fields are completed
on page one.
6. If the DNACPR is withdrawn the Single Point of Contact SPA HUB should be informed
immediately so that the DNACPR can be removed from the patients address on the CAD
system.
WMAS - October 2009
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