Do Not Attempt Cardiopulmonary Resuscitation 1669.pdf

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$Clavicle fracture - children.pdf - East Cheshire NHS Trust$

1.0 Policy StatementCardiopulmonary resuscitation (CPR) may be attempted on any individual for whom cardiac orrespiratory function ceases. Such events are inevitable as part of dying. CPR can theoreticallybe used on every individual prior to death. However, in some people this would beinappropriate, futile or against the individual’s wishes. It is therefore essential to distinguishthose patients for whom CPR would be inappropriate.2.0 BackgroundThe factors surrounding a decision whether or not to initiate CPR involve complex clinicalconsiderations and emotional issues. The decision for CPR of one patient may be inappropriatein a superficially similar case.In conjunction with the General Medical Council (GMC) a joint statement by the British MedicalAssociation (BMA), the Royal College of Nursing and the Resuscitation Council (UK) wasissued in October 2007. Recommended standards for recording DNAR (Do Not AttemptResuscitation) decisions were issued in 2009 by the Resuscitation Council. The GMC alsopublished guidelines – Treatment and care towards the end of life: good practice in decisionmaking – in July 2010.The aforementioned guidelines have been used to prepare this document.This policy respects the individual’s absolute right to life in accordance with the Human RightsAct (1998) and the Mental Capacity Act (2005).Copies of this policy are circulated to all wards and clinical departments within the Acute settingof East Cheshire NHS Trust. The policy is also available on the Trust’s website. Within the inpatientareas information leaflets (Ref: 10172) are available to all who may wish to consult them,including patients, families and carers (“Decisions about Cardiopulmonary Resuscitation”).Further information about these issues can be obtained from the Resuscitation Officer.3.0 Organisational Responsibilities3.1 Chief ExecutiveHas ultimate responsibility for the implementation and monitoring of this policy. Thisresponsibility may be delegated to an appropriate colleague, for example the Medical Director.3.2 All DirectorsDirectors are responsible for the implementation of this policy; the Medical Director isresponsible for ratifying this policy.3.3 The Resuscitation CommitteeThe Resuscitation Committee is responsible for the development, consultation and approvalprocess of this policy. The committee is also responsible for reviewing the policy to ensure thatit follows the latest best practice.3.4 The Resuscitation OfficerThe Resuscitation Officer is a full member of the Resuscitation Committee and is responsible formonitoring compliance with this policy.Do Not Attempt Cardiopulmonary Resuscitation PolicyResuscitation OfficerVersion 5.0 May 124
3.5 Ward/Department/Service Managers including ConsultantsManagers are responsible for ensuring relevant staff have access to the policy, are trained in itsimplementation and are aware of a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)decision which has been appropriately documented.4.0 Application4.1 For many patients the likelihood of cardio-respiratory arrest is small and no clinicaldecision is made in advance of such an event. If cardio-respiratory arrest does occurunexpectedly, CPR should be attempted.4.2 In some people there is an identifiable risk of cardiac or respiratory arrest, such as anunderlying incurable condition (such as advanced cancer), the history (such as recentmyocardial infarction or stroke), or current clinical condition (such as severe sepsis). If there is arisk of cardiac or respiratory arrest a decision should be made in advance about theappropriateness of CPR whenever possible.4.3 A DNACPR order (Red Form) applies only to in-patients of East Cheshire NHS Trust.The order (see appendix 1) refers solely to cardiopulmonary resuscitation; i.e. in the event of acardiac or respiratory arrest no attempts at cardiopulmonary resuscitation will be made. All othertreatment and care, where appropriate, shall not be precluded or be influenced by a DNACPRdecision.4.4 The decision is only valid during the patient’s current in-patient admission and isautomatically revoked on discharge from hospital. If still applicable, another DNACPR decisionmay be made on subsequent admissions. A new form will need to be completed for each inpatientepisode.4.5 The decision not to undertake CPR on a patient is taken following appropriateconsideration of the likely clinical outcome and the patient’s known wishes. The followingguidelines may support a decision not for CPR:4.5.1 Where attempting CPR would not restart the patient’s heart and breathing.If the health care team is as certain as it can be that attempting CPR would notrestart the patient’s heart and breathing because of the patient’s clinicalcondition, the patient cannot gain any clinical benefit from an attempt. Thisshould be a team decision and based on clinical assessment of the patient’scondition and up-to-date clinical guidelines and in the patient’s best interests.4.5.2 Where there is no benefit in restarting the patient’s heart and breathing.If the patient is terminally ill and death is inevitable within a short period of time,then that person should be allowed to die naturally with full comfort and palliativemeasures.4.5.3 Where the expected benefit is outweighed by the burdens of resuscitation.Where CPR may be successful in restarting the patient’s heart and breathing,and thus prolong the patient’s life, the benefits to be gained from the prolongationof life must be weighed against the burdens to the patient of the treatment.Again, this should be a team decision and based on clinical assessment of thepatient’s condition and up-to-date clinical guidelines and in the patient’s bestinterests.Do Not Attempt Cardiopulmonary Resuscitation Policy5Resuscitation OfficerVersion 5.0 May 12
Page 3: ContentsPage4 1.0 Policy Statement4
Page 7 and 8: Trust’s Interpreting Policy for i
Page 9 and 10: 7.2 A DNACPR decision should be rev
Page 11 and 12: ReferencesA Joint Statement from th
Page 13 and 14: Guidance notes to assist with compl
Page 15 and 16: RACE:From the evidence available do

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