DNACPR Policy

Seven Steps Short Breaks

Policy Statement

This policy is intended to be utilized in the context of caring for individuals who have been deemed to meet one (or more) of the following criteria by a senior clinical or medical practitioner:

CPR has been discussed with the individual. CPR is against their wishes and they have been deemed to have mental capacity to make that decision.
CPR is against the individuals wishes as recorded in a valid advanced directive/decision (Over 18).
The outcome of CPR would not be of overall benefit to the patient and they lack capacity to make the decision around CPR or declined to discuss the decision. The decision has been discussed with relatives or other relevant person(s).
CPR would be of no clinical benefit due to a diagnosis of specific medical condition(s).

The policy also aims to be consistent with the code of practice developed under the Mental Capacity Act 2005, since people in need of resuscitation by definition might also be lacking capacity at the time to take key decisions on their subsequent treatment.

Because of the Tracey Judgement (2014), all NHS trusts have a legal duty to consult with and give the individuals with capacity opportunity to express their views and inform the individual if a DNACPR order is placed on their records. As an organization, we confirm with our residents and/or their responsible person that they are aware that a DNACPR is in place and have had the opportunity to discuss their views. This is an integral part of respecting an individual’s dignity.

The Policy

This organization works on the basis that everyone has the right to make choices and decisions about their treatment in the event of their needing to be resuscitated, and that these wishes should be respected if the situation arises.

As far as possible, people’s wishes should be ascertained and recorded as ‘advance decisions’ (a term used in relation to the Mental Capacity Act 2005) on their service plan, taking into account that this process will require sensitive and careful handling.

The person’s capacity to take an advanced decision for themselves regarding their possible resuscitation also requires consideration. For example, if there is any doubt about the validity of an advanced decision then it would be incumbent to attempt resuscitation or to seek medical help to do so.

If it is clear that the person has made an advance decision against being resuscitated under certain conditions then this needs to be respected, as should any associated wish such as keeping the decision confidential from relatives and others.

This organization may need to clarify its ethical and legal position in cases, for example, where there are doubts about a person’s mental capacity to make advance decisions, or where there are doubts about the authenticity of any representation of the person’s views. (In such instances there can be no reasonable belief that the person has taken such an advanced decision and attempts at resuscitation would then follow)

Procedures

This organization attempts to elicit from all of its clients, in relation to its contractual obligations to them and their care planning, whether:

A. They have made an advance decision regarding their treatment, and if so whether this decision has been lodged with their medical practitioner. B. They might wish to make such a decision.

This organization ensures such issues are dealt with, particularly in situations where there is a clear risk that the resident could require resuscitation at some point.

This organization will clearly communicate to the resident and their representatives its expectations of what its staff should do under those circumstances. These are recorded on the clients’ care planning.

In incidents of sudden or unexpected collapse, where a person has clearly not made any advanced directive or given any indication of their views on resuscitation, the organization expects staff to take all necessary steps to seek emergency help and act as promptly as possible and follow instructions given and provided by statutory bodies (Specifically and namely: NHS Organizations including and more than likely the Yorkshire Ambulance Service).

In all cases, organization staff are instructed to summon medical help and the emergency services without delay and follow all instructions given to them.

Where an individual has a valid DNACPR, it is the policy of this organization that no attempts at resuscitation are undertaken by its staff, however, they are still expected to provide usual standards of help and comfort, e.g., pending the arrival of the emergency services or medical help.

This organization takes resuscitation and emergency care into account when allocating staffing resources; however, it cannot be guaranteed that staff will be fully competent or qualified to provide assistance in any given emergency situation, hence the emergency services will always be called. Further interventions will then be directed by the medical or clinical practitioner. If organization staff are aware that the individual has made an advance decision/directive, or there is a reasonable belief that they do not wish to be resuscitated, then they should pass this information to the medical team.

All staff receive guidance and learning opportunities to clarify their attitudes and feelings over such issues and to understand their respective roles and responsibilities in such situations.

Additional Notes

An advance decision communicates the sort of treatment a person wants for different levels of illness, such as a critical or terminal illness, permanent unconsciousness or dementia in the event of their losing the capacity to communicate their wishes at the time. As a document, an advance decision might include a number of specific advance decisions, of which being either for or against resuscitation might be included.

An advance decision indicates to medical doctors and health professionals that the person does not want certain types of treatment, such as to be put on a ventilator if in a coma. But it can also say that the person would like a certain treatment, or to receive whatever treatment is available that might keep them alive.

An advance decision only comes into effect when a person is terminally ill (which generally is held to mean less than six months to live), e.g., with widespread cancer. An advance directive does not let the person choose another person to make decisions for them, unless it specifically appoints a proxy.

Training Statement

Where applicable, we will endeavor to train our staff on each individual’s DNACPR; however, all our staff have first aid training, including Basic Life Support (BLS), as part of our mandatory training.