DNACPR and Advanced Care Planning

Question 1

What is a DNACPR?

Answer 1

Do not attemtp CardioPulmonary Resuscitation
No emergency procedure will be used to restart a persons heartbeat and breathing after one or both have stopped - this includes chest compressions, rescue breaths and medical interventions

Question 2

What are the risks associated with CPR?

Answer 2

Low success rate - 25% in hospital and 9% in the community
Injury from CPR - rib fractures
Complications following cardiac arrest e.g hypoxic brain injury
Not returning to baseline function following cardiac arrest
Distress to patients loved ones.

Question 3

What factors are considering in a DNACPR decision?

Answer 3

Co-morbidities and diagnosis
Functional status
Patient and family wishes
How likely is it for CPR to be successful for this patient?
Is it in the patients best interest to perform CPR in a cardiac arrest?

Question 4

What information is included on a DNACPR form?

Answer 4

Patient details
Reasons for completing forming/why needed
Details around the discussion - who with, what other plans do they currents have in place, can it be shared with others?
Signature by junior (F2 and above) - active for 24hrs
Signature by senior - active for 1yr
Contact information
Review dates and signs

Question 5

How often should a DNACPR be reviewed?

Answer 5

Yearly

Question 6

What steps are important when discussion a DNACPR?

Answer 6

1. Introduce yourself - confirm details and relation to patient if not patient
2. Explore understanding of current health - confirm/reassure
3. Assess is patient is aware of conversation topic today.
4. Make steps towards future care planning - emphasise if unwell in future - which we are unable to predict - reassure not expecting anything to happen right now - to be prepared for the future - very unwell so as heart and lungs may stop
5. Reassure that would not affect other treatment - receiving everything to prevent arrest, would only come into place when an arrest occurs.
6. Re-iterate that CPR would be highly unlikely to have a successful outcome
7. Emphasise that a medical team discussion
8. Confirm understanding - ask to summarise back

Question 7

What is meant by advanced care planning?

Answer 7

A plan made with patients to outline their wishes regarding their medical treatment, should their health deteriorate and/or they become unable to communicate those wishes
Often used when health deteriorates, long term illness diagnosis or life limiting illness diagnosis
Can include refusal of treatments, plans to prevent further admission and end of life care decisions.

Question 8

What are the different aspects of an advanced care plan?

Answer 8

Advanced statements - not legally binding, useful to outline patients wishes - for example a DNACPR
Lasting power of attorney - health and wellbeing and financial (can be same or different people) - legally nominate other person to be in charge of decision when patient lacks capacity
Advance decision - legally binding documents, enable patients to outline wishes and refuse certain treatments.

Question 9

What is a respect form in terms of advanced care planning for a patient?

Answer 9

Include if have a DNACPR
Specific aspects of patient care - preference on balance of comfort and life extending treatment, patients capacity, emergency contacts, other advanced decision forms and where to find them.
Advanced Care Plan Summary

Question 10

Define frailty

Answer 10

Clinically recognised state of increased vulnerability.
Results from ageing associated with a decline in the body physical and psychological reserves

Question 11

What are the different domains in a comprehensive geriatric assessment?

Answer 11

Function - ADLs, TUG
Health - comorbidities
Cognition - MMSE, MOCA
Nutrition - BMI, MUST
Psychological - Geriatric depression score
Medications
Environment and social support