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

OBJECTIVES OF THE POLICY

1. To ensure a consistent and integrated approach across Scotland to DNACPR decision-making and communication for all patients in all care settings in line with national good practice guidance.

2. To ensure that decisions regarding CPR are made according to:

• whether CPR could succeed
• the clinical needs of the patient
• the patient's wishes and their judgement of the benefit provided by CPR
• current ethical principles
• legislation such as the Human Rights Act (1998) and Adults with Incapacity (Scotland) Act 2000.

3. To make DNACPR decisions transparent and open to examination.

4. To ensure that a DNACPR decision is communicated to all relevant healthcare professionals and services involved in the patient's care.

5. To avoid inappropriate CPR attempts in all care settings.

6. To ensure staff, patients and their relevant others have appropriate information on making advance decisions about CPR and that they understand the process.

7. To clarify that patients and their relevant others will not be asked to decide about CPR when it would clearly fail and therefore is not a treatment option, or when the circumstances of a possible cardiopulmonary arrest cannot be anticipated and therefore informed discussion cannot take place.

8. To encourage and facilitate open, appropriate and realistic discussion with patients and their relevant others about resuscitation issues.

9. To clarify the DNACPR decision-making process for clinical staff caring for people who have communication difficulties and other vulnerable groups.

Scope of the NHSScotland DNACPR Policy

This policy applies to all NHSScotland Staff and the care of adult patients in all care settings within the remit of NHSScotland. Independent care organisations and facilities are encouraged to make use of this NHSScotland policy for the benefit of their patients.

This policy is specifically about cardiopulmonary resuscitation ( CPR). That is attempted restoration of circulation and breathing in someone in whom both have stopped. It does not apply to other treatment and care, including procedures that are sometimes loosely referred to as "resuscitation" such as rehydration, blood transfusion, IV antibiotics etc.

It is implicit in this policy that generally recommended practice may be modified for the unusual circumstances of a particular case. It is then of prime importance to record what was done, with reasons why, in the case notes so that it can be justified afterwards.