Do Not Attempt Cardiopulmonary Resuscitation 1669.pdf

5.9 Occasionally discussion with patient and/or family members may not be appropriate andin these cases the doctor should use his/her discretion. An example would be a patient who is inthe last days of life, at the end of a terminal illness, and the family are aware he/she is dying. Anexplanation for not involving the patient, or relatives, in the decision-making process should bedocumented on the DNACPR Order (Red Form) – e.g. patient lacks capacity and relatives notavailable.5.10 The initial decision not to provide CPR should be made by the most senior doctoravailable in charge of the patient’s care (i.e. registered doctor – F2 or SHO grade, or above)after discussion with the registered nurse responsible for the patient’s care and other membersof the multidisciplinary team involved in the patient’s care.5.11 DNACPR orders should also be recorded for patients expected to die imminently inwhom resuscitation could not be successful. If this is not done, first responders are obliged toinitiate a resuscitation attempt in accordance with the Trust CPR Policy.5.12 In cases of expected death where it has been recorded that the patient is not forresuscitation, designated nurses with the appropriate training may verify the patient’s death inthe absence of a doctor.6.0 Documentation and Communication6.1 The DNACPR order is printed on a single sheet of Red A4 paper as shown in appendix1. The form must be completed in full, and no abbreviations are permitted. It must be dated andsigned with the doctor’s name and position (section 6). The guidelines for the use of the formare printed on the reverse.6.2 The doctor recording the decision should insert this form securely into the front of thepatient’s medical records and document the decision in the case notes. If applicable stateclearly what was discussed and agreed with the patient or health proxy.6.3 It is the responsibility of this doctor to ensure the decision is communicated to theregistered nurse responsible for the patient’s care. This nurse should be involved in the decisionmaking process and must enter their name, signature, position and the date in section 5 of theRed Form.6.4 It is the duty of this nurse to ensure that this decision is communicated to all otherrelevant members of staff and documented in the nursing notes.7.0 Endorsement and Review of a DNACPR Order7.1 The DNACPR order must be reviewed and endorsed before the end of the next day bythe most senior healthcare responsible for the patient’s care, i.e. Consultant or doctor withequivalent responsibility. If he/she is unable to attend to sign personally, this may be delegatedto a Registrar/Middle Grade doctor, who has seen and reviewed the patient and discussed theDNACPR decision with the Consultant (or equivalent) by telephone communication; directlyafter the telephone communication the Consultant’s (or equivalent) name and position must beentered on the DNACPR Order by the Registrar/Middle Grade doctor.Do Not Attempt Cardiopulmonary Resuscitation PolicyResuscitation OfficerVersion 5.0 May 128