Cardiopulmonary resuscitation decisions - integrated adult policy: guidance

Objectives of the Policy

1. To ensure a consistent and integrated approach to CPR decision-making, documentation and communication across Scotland for all patients in all care settings (including the patient's own home or care home) in line with national good practice guidance ( BMA 2016).

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

- whether CPR could be successful in achieving sustainable life

- the clinical needs of the patient

- the patient's wishes and their judgment of the overall benefit provided by CPR where it might be successful

- current ethical principles

- legislation such as the Human Rights Act (1998) and Adults with Incapacity (Scotland) Act 2000

- international human rights instruments such as the European Convention on Human Rights and the UN Convention on the Rights of Persons with Disabilities.

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 and support good end of life care in all health, social and home 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, and that patients and relevant others understand their rights if they are in disagreement with the care team.

7. To clarify that patients, and their relevant others will be sensitively informed of, but will not be asked to make a decision about, CPR when it is not a treatment option that would work.

8. To clarify that patients, and their relevant others, cannot demand any treatment (such as CPR) that is judged to be clinically inappropriate.

9. To clarify that patients, and their relevant others will not be asked to make an advance decision about CPR when the circumstances of a possible cardiopulmonary arrest cannot be anticipated and therefore informed discussion about CPR harms and benefits cannot take place.

10. To encourage and facilitate honest, sensitive, appropriate and realistic discussion with patients and their relevant others about CPR in the context of their individual situation and goals of care.

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