DNACPR Flashcards
how is it decided to have a DNACPR
¥ The decision to offer CPR is a medical one
¥ Nothing to do with ‘quality of life’
¥ If CPR is likely to be futile do not offer it
¥ If success not anticipated – inform patient
¥ If success anticipated - discussion needed
¥ Relatives should not be asked to ‘decide’ unless legally empowered to do so
Do we discuss DNACPR when CPR will not work?
“If the healthcare team is as certain as it can be that a person is dying as an inevitable result of underlying disease or a catastrophic health event and CPR would not re-start the heart and breathing for a sustained period, CPR should not be attempted”
“In most cases people should be informed, but for some, for example those who know that they are close to the end of their life, such information may be so distressing as cause the person as to suffer physical or psychological harm”
what needs considered if an arrest is not anticipated
¥ No further thinking about DNACPR is required
¥ Do not burden the patient with having to make a decision about resuscitation
¥ In the unlikely event they have a cardiac arrest attempt resuscitation unless it clearly would not work
what needs considered if CPR is realistically likely to succeed
¥ Discuss with patient
¥ Document decision following discussion
¥ Inform family/loved ones
¥ Inform others
what needs considered if CPR is realistically likely to not succeed
¥ Do not offer CPR
¥ Discuss DNACPR decision
¥ Inform (Sensitively!) family/loved ones
¥ Inform others
what is the DNACPR Decision Making Toolkit
¥ Decision making framework to assist medical and nursing staff in all settings
¥ Single, high visibility, widely recognisable, self-explanatory DNACPR form designed to follow the patient and contain all info needed by community, acute and ambulance services
¥ Patient information booklet to improve patient and relative awareness, and assist discussions
what is the purpose of a DNACPR form
to prevent inappropriate resuscitation attempts where it clearly would not work or would not be wanted by the patient
what is wrong with inappropriate resuscitation attempts
causes significant harm and distress to a patient and the family as a death during or just after CPR will be highly undignified and traumatic
what communication must there be once DNACPR has been decided
Document the decision: DNACPR form, DN records, GP records
Inform others ¥ ePCS/eKIS ¥ GGC OOH Medical Service ¥ Acute receiving units ¥ Scottish Ambulance Service
Telephone etc
¥ OOH District Nursing Services
¥ Specialist palliative care e.g. hospice
¥ Acute Services e.g. respiratory team
