Case study:

23 July 2010

South East Coast DNACPR principles

Key points

The NHS South East Coast EoLC Clinical Advisory Group has agreed a set of overarching principles for Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR).

The principles, which set out a framework for organisations to align their DNACPR policies with, should ensure consistency in the application of DNACPR across the region, allowing ‘portability’ of decisions across care settings in line with best clinical practice. They are due to be formally ratified in January 2010.

The key principles for DNACPR policies are that they:

• Apply to adults over 16
• Apply to all care settings and are transferable from one setting to another, including while the patient is in transit
• Must be compliant with the joint statement from the BMA, the Resuscitation Council and the RCN, the NMC advice statement and GMC guidance on withdrawing withholding treatment.
• Recognise that the DNACPR form remains valid from the date of signing unless a review date has been specified
• Recognise that a review date does not have to be specified.

The responsibility for decision-making and CPR will always rest with the most senior clinician currently in charge of the patient’s care. In most cases this will be the consultant or GP, although they may delegate the responsibility to another registered medical practitioner. In certain settings an experienced nurse may be the senior clinical decision-maker.

Wherever possible, a decision should be agreed by two senior members of the health care team responsible for the patient’s care and treatment.

The health care professional making the decision needs to be competent to answer three questions when deciding whether to embark on CPR:

• Is a cardiac arrest likely?
• Is an attempt at CPR likely to be successful?
• Has the patient the capacity to be involved in decision-making?

It has also been agreed to use the standard Resuscitation Council DNACPR form across the region. This will be the patient’s property to ensure portability. A duplicate ‘decision record’ form will be produced for the care record and can be used to communicate decisions to others involved in the patient’s care as well as the ambulance service, GP/ OOH service. The duplicate will not be considered an active form and can be copied. This means there is only one active document to cancel if a decision is reversed.

Nurses will undertake a training programme and competency assessment as part of an extended role. The programme and competencies will be in line with those agreed by the SHA Clinical Advisory Group.