Do Not Attempt Resuscitation (DNAR) Decisions in the ... - aagbi

9. Duration of the DNAR
management option
Intraoperative phase
The DNAR management option should apply for the duration of
the patient’s stay in the theatre environment. If premedication
is prescribed it must be used with extreme caution to avoid
alterations in the patient’s physiological status before transfer to
theatre.
All theatre staff should be made aware of the DNAR
management option of the patient throughout their time in the
theatre suite and recovery area. The anaesthetist and surgeon
involved in preoperative consultation should be present in
theatre throughout the procedure to enable shared responsibility
of resuscitation decisions. In some circumstances this may
not be possible; good communication of decisions from the
preoperative consultation is therefore essential.
Postoperative phase
The DNAR management option should be communicated to the
recovery staff on transfer to the recovery area. This option will
continue until the patient is discharged from the recovery area.
The prior DNAR decision should be reinstated on handover of
the patient to the nursing staff from the ward. In exceptional
circumstances, arrangements may be made to prolong the
DNAR management option following transfer to the ward
postoperatively: for example, if a patient-controlled analgesia
device or epidural infusion is to be used in the postoperative
period. A postoperative review of the patient should be
carried out with communication to the patient, relatives or
proxy decision makers about the perioperative management if
necessary.
There should be regular audits of the management of patients
with DNAR decisions scheduled for surgery.
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