Case study:

11 May 2010

Working with ambulance staff in the North West

Key points

North West Ambulance Service (NWAS) is taking part in a pilot study designed to ensure that patients’ wishes not to be resuscitated are respected wherever possible in GP practices.

A Do Not Attempt to Resuscitate (DNAR) order has to be agreed in consultation with the patient and family as well as the multidisciplinary team caring for the individual.

The reasons for a DNAR may include:

Where competent patients express a desire not to be resuscitated.Where cardiopulmonary arrest is the end result of a disease process where appropriate treatment options have been exhausted. Where resuscitation would be followed by a duration or quality of life that would be unacceptable to the patient.

The pilot study guidance – which may eventually form the basis of a new policy for the whole of Oldham PCT indicates that any agreed DNAR must be communicated to relevant healthcare professionals such as the ambulance crew.

The guidance stresses that patients should be aware that the primary role of the ambulance service is to save life and prevent further deterioration.

They should therefore only call an ambulance as a last resort when other clinicians are unable to respond

A copy of any DNAR order – which has to be reviewed every four days – will be sent to the NWAS so that ambulance crews are aware of the situation before responding to specific calls.

But if a DNAR is not valid and the wishes of the patient cannot be verified, then resuscitation should go ahead.

Everyone involved in the pilot will be invited to share their views and to provide comments and feedback, both good and bad, about their experiences of the process.

The plan is to roll this out to care homes.