Resuscitation Policy (DNAR) July 12 - Royal Bournemouth Hospital

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Appendix 1Is cardiac or respiratoryarrest a clear possibilityin the circumstances ofthe patient?NOIf there is no reason to believe that the patient is likely tohave a cardiac or respiratory arrest it is not necessary toinitiate discussion with the patient (or those close to patientswho lack capacity) about CPR. If, however, the patient wishesto discuss CPR this should be respected.YESIs there a realisticchance that CPR couldbe successful?YESNOWhen a decision not to attempt CPR is made on these clearclinical grounds, it is not appropriate to ask the patient’swishes about CPR, but careful consideration should be givenas to whether to inform the patient of the DNAR decision(see section 6.)Where the patient lacks capacity and has a welfare attorneyor court-appointed deputy or guardian, this person should beinformed of the decision not to attempt CPR and the reasonsfor it as part of the ongoing discussion about the patient’scare (see section 6).If a second opinion is requested, this request should berespected, whenever possible.Does the patient lackcapacity and have anadvance decisionrefusing CPR or awelfare attorney withrelevant authority?YESIf a patient has made an advance decision refusing CPR, andthe criteria for applicability and validity are met, and the advancedecision meets the documentation requirements stipulated in theMental Capacity Act, this must be respected. If an attorney,deputy or guardian has been appointed they should be consulted(see sections 8 and 9).NOAre the potential risksand burdens of CPRconsidered to begreater than the likelybenefits of CPR?YESWhen there is only a very small chance of success, and thereare questions about whether the burdens outweigh thebenefits of attempting CPR, the involvement of the patient(or, if the patient lacks mental capacity, those close to thepatient) in making the decision is crucial. When the patientis a child or young person, those with parental responsibilityshould be involved in the decision where appropriate. Whenadult patients have mental capacity their own view shouldguide decision-making (see section 7).NOCPR should be attempted unlessthe patient has capacity andstates that they would not wantCPR attempted.ooooDecisions about CPR are sensitive and complex and should be undertaken by experienced membersof the healthcare team and documented carefullyDecisions should be reviewed regularly and when circumstances changeAdvice should be sought if there is uncertainty.Flow chart adapted from the Decision-Making Framework published by the BMA.The Royal Bournemouth & Christchurch Hospitals NHS Foundation TrustResuscitation/Do Not Attempt Resuscitation (DNAR) Policy (July 2008) Reviewed Jan 2011Author: Resuscitation Committee Page 8 of 11
Royal Bournemouth & Christchurch Hospitals NHS Foundation TrustDO NOT ATTEMPT CARDIOPULMONARY RESUSCITATIONAdults aged 16 years and overNameAddressDate of birthNHS or hospital numberDate of DNAR order:/ /DO NOT PHOTOCOPYIn the event of cardiac or respiratory arrest no attempts at cardiopulmonary resuscitation (CPR)will be made. All other appropriate treatment and care will be provided.1 Does the patient have capacity to make and communicate decisions about CPR?If “YES” go to box 2YES / NOIf “NO”, are you aware of a valid advance decision refusing CPR which is relevant tothe current condition?” If “YES” go to box 6If “NO”, has the patient appointed a Welfare Attorney to make decisions on their behalf?If “YES” they must be consulted.YES / NOYES / NOAll other decisions must be made in the patient’s best interests and comply with current law.Go to box 22Summary of the main clinical problems and reasons why CPR would be inappropriate,unsuccessful or not in the patient’s best interests:3Summary of communication with patient (or Welfare Attorney). If this decision has notbeen discussed with the patient or Welfare Attorney state the reason why:4Summary of communication with patient’s relatives or friends:5Names of members of multidisciplinary team contributing to this decision:6Healthcare professional completing this DNAR order:NamePositionSignature Date Time7Review and endorsement by most senior health professional:Signature Name DateReview date (if appropriate)Signature Name DateSignature Name Date
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Resuscitation Policy (DNAR) July 12 - Royal Bournemouth Hospital

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