Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) - integrated adult policy: guidance

THE DNACPR FORM

The DNACPR form is a means of communicating the decision that has been made to those who may encounter the patient in the event of a cardiopulmonary arrest. A clinical team that knows the patient and is certain of the background to the decision should not regard the decision as invalid simply because a form has been incorrectly completed.

The presence or absence of a DNACPR form should not override clinical judgement about what will be of benefit to the patient in an emergency (e.g. choking, anaphylaxis, sepsis etc).

If you are as certain as you can be that CPR would realistically not have a medically successful outcome in terms of achieving sustainable life (following the Framework above) a DNACPR form should be completed and used to communicate this information to those involved in the patient's care. It is important that all relevant healthcare and social care professionals involved in the patient's care are aware that a DNACPR decision has been made and a DNACPR form exists. In order to facilitate this, the original DNACPR form should be immediately accessible wherever the patient is being cared for.

Where a patient is moving to a different care setting a photocopy of the original form may be retained for medical record audit purposes. A line should be drawn through the photocopy to make it clear that it is not the valid DNACPR form, before it is filed in the records.

Where a patient is at home, they and/or their relevant others must have been made aware of the DNACPR form for it to be of any use in an emergency situation. Where this information has not been given the form must not be sent home with the patient.

When a patient is being transferred to a different care setting it is necessary for the ambulance crew involved to have the original DNACPR form or verbal confirmation that the DNACPR form exists. The crew must also be informed of whether there has been discussion with the patient and family about the DNACPR form prior to the journey. This ensures compliance with the Scottish Ambulance Service End of Life Care Plan.

The Out of Hours Service must be made aware of the existence of the DNACPR form when the patient is being cared for in the community. They should also be informed where appropriate if this DNACPR decision is reversed.

Where a DNACPR decision is being reversed the form should be clearly scored through with a black pen and the word "reversed" written across it. The invalid form should then be filed in the back of the medical notes.