Case study:

11 May 2010

End of Life Care and the Ambulance Service – an integrated approach in North West Ambulance Service NHS Trust

Key points

Do Not Attempt Resuscitate orders (DNAR) have been a cause of significant concern to professionals, patients and their families in addressing their wishes at the end of their life.

Work is currently being undertaken on this topic at national level.

But the following example shows how the North West Ambulance Trust, working in partnership, is addressing this issue.

Ambulance staff in Oldham are testing out a standardised DNAR form aimed at respecting the wishes of palliative care patients at the end of their lives.

The project is a joint pilot between Oldham Primary Care Trust, the North West Ambulance Service NHS Trust (Greater Manchester Area) and the Macmillan Palliative Care Team from the Royal Oldham Hospital – part of the Pennine Acute Hospitals NHS Trust.

The project aims to develop and evaluate a care pathway for ambulance staff that will encourage more integrated working with other health and social care teams – and so reduce the need for hospital admissions at the end of patients’ lives.

It is also hoped the model may be transferable to other primary care settings and areas of the local health economy – and that it will help educate patients, relatives and healthcare professionals about the role of the ambulance service in end of life care.

So far organisers have developed a standard DNAR form and a care pathway for ambulance clinicians.

They have also identified the pilot sites and produced a DNAR guidance and awareness pack for health and social care professionals.

The type of situation where a DNAR form might be appropriate includes:

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 responsibility for a DNAR decision lies with a patient’s GP or consultant.

In their absence, a senior clinician or nominated deputy may be responsible for the DNAR decision.

Ideally, in the event of cardiac or respiratory arrest where a DNAR is in place, an ambulance should only be called out as a last resort when other care teams or clinicians are unable to respond.