A Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision, also known as a Do Not Resuscitate (DNR) order, is a medical directive that instructs healthcare professionals not to perform cardiopulmonary resuscitation(CPR) if a person’s heart stops or they stop breathing. This decision is typically made for individuals for whom CPR would not be effective or when the risks and burdens of resuscitation outweigh the potential benefits. DNACPR decisions are made to respect the individual’s wishes and best interests, and they carry significant responsibilities for care providers.
A DNACPR order is a formal document signed by a medical professional and must be easily accessible to everyone involved in the person's care. The following places are recommended for storing DNACPR decisions:
1. Physical Copies:
These should be stored in a visible location, such as with the person's care records at home or in an accessible folder.
2. The Message in a Bottle Kit
Those who live in their own home may keep the order in the Message in a Bottle Kit. The Message in a Bottle Kit usually includes a form to complete that people put inside the bottle and keep in their fridge - ideally in the door to allow it to be found quickly in an emergency.
Two stickers are also provided to let paramedics know about the bottle. One should be stuck on the fridge door, and the other inside the front door. Some people who don’t want a sticker on their fridge, put the other sticker close to their back door.
3. Electronic Records:
Digital systems can securely store verified DNACPR orders, providing rapid access for relevant care staff. Platforms like Careberry can display warnings to care staff, ensuring they are promptly informed about an individual's DNACPR status.
The Role of Care Companies in Managing DNACPRs
Care companies have a vital role in ensuring that DNACPR decisions are upheld while maintaining high standards of care. Their responsibilities include:
1. Verification of DNACPR Status:
Verify that the DNACPR decision is valid, signed by a qualified medical professional, and reflects the individual’s current wishes and health status.
2. Clear Communication:
Ensure that all relevant staff are informed of a person’s DNACPR status through proper documentation and communication. This minimises confusion during emergencies and helps staff respond appropriately.
3. Provision of Standard Care:
A DNACPR decision pertains only to CPR and does not imply "do not treat." Care staff are required to continue providing all other essential care activities, including pain management, emotional support, and comfort measures.
4. Actions During Emergencies:
In an emergency, carers should:
1. Avoid CPR as per the DNACPR decision.
2. Provide other forms of care to ensure the person’s comfort and dignity.
3. Notify emergency services and present the DNACPR documentation to ensure clarity and compliance. Emergency services may make a best interest decision if they are called out.
It is crucial for individuals to understand the implications of a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision. The NHS highlights the importance of clear communication throughout the decision-making process. If a care provider finds themselves in a situation where a client seems unaware of their DNACPR decision:
1. Notify Appropriate Authorities:
Contact the individual’s GP, social worker, or legal representative to ensure the situation is reviewed.
2. Support the Individual:
- Provide clear, accessible information about their rights and options.
- Facilitate discussions with the individual, their family, and health care professionals to ensure informed consent.
3. Advocate for Transparency:
Ensure that DNACPR decisions are revisited and explained regularly to align with the person’s evolving circumstances and preferences.
A DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) form can be created for a limited duration, such as during a hospital stay, or for an indefinite period,usually for long-term conditions that impact vital organs. It should be reviewed whenever circumstances change, such as when a patient is discharged from the hospital. The review schedule must be clearly communicated and documented on the form. Additionally, any DNACPR issued by the hospital will be noted in the discharge summary and shared with the person's GP.
A DNACPR form is not legally binding; it serves as guidance for healthcare professionals regarding the decision to avoid CPR. To make this decision legally binding, one must create an Advance Decision to Refuse Treatment (ADRT), which specifies the circumstances under which CPR or other treatments should be refused.
Managing DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) decisions requires a careful balance of trust, transparency, and effective communication. Care providers must prioritise their clients' dignity, autonomy, and well-being while adhering to legal and ethical guidelines. By utilising tools like Careberry and following best practices, care companies can ensure that DNACPR decisions are respected and implemented with the highest level of care and professionalism.
