Making Decisions About Resuscitation Flashcards
What should be considered when making a decision about resus?
- The pt’s individual circumstances
- Most up-to-date evidence and professional guidance
When should CPR NOT be offered or attempted?
- Clinical team believes that CPR will NOT restart their heart & breathing for a sustained period as the pt. is dying from an underlying disease or catastrophic health event
- There is no realistic possibility of a successful outcome
What to do if a person with capacity refuses CPR?
- Must be respected
In England & Wales, if a person lacking capacity has a valid & applicable Advance Decision to Refuse Treatment (ADRT) specifically refusing CPR, what do you do?
- Respect
- No CPR
- This is legally binding
Who makes a decision about CPR?
- Senior clinician responsible for the pt’s care.
Who should be involved when a decision about future CPR is being considered?
- Pt should be involved in the decision-making process whenever possible
What to do if a person lacks capacity to make decision about CPR?
- Those close to them (relatives) must be involved in discussions
- To inform a ‘best-interests’ decision
If A do not attempt cardiopulmonary resuscitation (DNACPR) decision has been made, what does it mean for other Rx?
- Other Rx continues as usual
What is NB to document w.r.t CPR decisions?
- Reasons for them
- Discussions that informed those decisions
Ways to ensure good communication when making decisions about resus:
- Involving the pt. themselves
- Involving those close to the pt. (relatives)
- Clear explanation
- Provide information
- Avoiding misunderstanding
What to do if pt. lacks capacity to make decisions about CPR?
- Those close to them (relatives) must be involved in discussions
What to do if pt. lacks capacity to make decisions about CPR & CPR will not work?
- Explain why CPR won’t work to those close to the pt. (relatives)
- Explain why a DNACPR decision is needed
- Explain what it a DNACPR means
When can family members make decisions about resuscitation for pt?
- If they hold an applicable power of attorney or similar legal power to make decisions for the patient
- About consent to, or refusal of, life-sustaining Rx
Tips to explain decisions about resus to pt. so they understand:
- Use clear, unambiguous language
- Use a combination of verbal explanation & printed or digital info
- Provide acurate info
- Check understanding
- Ensure appropriate setting
- Allow adequate time
- Allow opportunities for discussion
What is the primary purpose of documentation in decisions with resus?
- To ensure that the decision
- The reasons for it
- The discussions that led to it
- Are available immediately to anyone present
When is the best time to discuss CPR options with pt?
- When relatively stable
- Have time
- Have opportunity to discuss & consider their wishes carefully
Every decision about CPR should be based on the …
- Individual circumstances of each person
Which of the following is it appropriate to involve in deciding whether or not to attempt CPR in the event of Mary having a cardiac arrest?
- Mary
- Her family
- All multi-professional team members involved in her care (GP, Community heart failure nurse)
In which 2 circumstances is it legally & ethically acceptable to make a CPR decision without discussion w/ the pt. or relatives?
- Having a discussion w/ pt. will cause phsyiological or psychological harm to them
- Pt. who lacks capacity & impracticable or inappropriate to contact relatives before a decision needs to be made
3 steps recommened in the ReSPECT process:
ReSPECT = Recommendation Summary Plan for Emergency Care & Treatment
- Determine what pt. thinks are the most relevant health conditions & understand the Px of these condtions
- Record what the pt. fears & values
- Record what interventions will result in the desired outcomes
If a pt. who lacks capacity has a legal proxy (attorney for health) what must you do?
- Involve that person in decision-making process
What is the role of an IMCA?
IMCA - Independent Mental Capacity Advocate
- Speak on behalf of pt. who lacks capacity
- Has no other representatives
Recording emergency care Rx plans - Ensure records include:
- Pt. identifier info
- Pt’ mental capacity
- Who was involved in making recommendations
- How Dr weighed pros & cons of Rx
- Recommended Rx & those which should not be provided
- Whether CPR should be attempted or not
Factors influencing decision when to stop CPR:
- Hx
- Px
- Cardiac arrest rhythm present
- Absence of response to initial resus
- Duration of resus
When to decide to stop CPR?
- Continuing CPR will not achieve ROSC
- Or outcome that would not be valued by pt.
In general, CPR should be continued in cases with …
- Shockable rhythm
- Or potentially reversible cause of cardiac arrest persists
