The purpose of a DNACPR recommendation is to provide immediate guidance to those present (mostly healthcare professionals) on the best action to take (or not take) should the person suffer cardiac arrest or die suddenly.
What is CPR?
CPR is Cardio-Pulmonary Resuscitation. When an individual’s heart stops beating and their breathing stops because they are dying from an advanced and irreversible condition, CPR will subject them to a vigorous physical intervention which risks depriving them, and those important to them of a dignified death. For some people this may prolong the process of dying and, in doing so, prolong or increase suffering. CPR is by no means always successful in restarting the heart and breathing.
For an easy read version of the Resuscitation Councils information leaflet click here.
The purpose of a DNACPR recommendation is to provide immediate guidance to those present (mostly healthcare professionals) on the best action to take (or not take) should the person suffer cardiac arrest.
The objectives of the ReSPECT process are to promote advance care planning, good communication, shared decision making, and good documentation with cross-boundary recognition. The resuscitation status of a person is only one aspect of the plan of emergency care and treatment.
Who decides?
An individual with capacity can choose not to have CPR and allow a natural death using an Advance Decision to Refuse Treatment (ADRT) or by telling their health care professional that they do not want to be resuscitated at the end of their life. Otherwise, a doctor or healthcare professional caring for the individual will make a clinical judgement about whether to attempt CPR based on the benefit/burden ratio of whether restarting the heart likely it is to be successful and in the best interests of someone who is nearing the end of their life. A patient or their family/paid carers should be involved in this sensitive conversation but cannot demand treatment as this is a medical decision. The professional should consult the patient and/ or their family to gather information about what their wishes would be if known. The individual (if appropriate) and their family/carers should always be made aware of the decision and talk them through the form that outlines this recommendation. Finding this information out without being included causes avoidable distress and this should be raised as a concern to the Community Learning Disability Nurses. Hertfordshire Safeguarding Adults Board have developed this Guidance so carers are clear on how these decisions should be made. DNACPR Support Guide
Once a decision has been made not to attempt CPR this will be recorded in the individual’s medical records. This is called a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision and would be recorded as part of the ReSPECT Form.
Who else will be involved in making the decision?
If the individual is very ill or lacks capacity, they might not be able to make decisions about their treatment and care. At this stage people who know the person well such as family and/or close friends may be asked their thoughts on the persons preferences. Any decisions should be made in accordance with the Mental Capacity Act. It is important to remember that no one can make unilateral decisions for an adult with a learning disability. Even if one of the individual’s family or friends has been given a Lasting Power of Attorney or a Health Deputyship, they cannot insist on CPR being used. A DNACPR decision is a clinical decision made by the clinical team in the absence of any other legally binding decision.