DO NOT ATTEMPT CPR

• Anticipate the likelihood of cardiopulmonary arrest
• if CPR may be inappropriate, discuss DNACPR status with patient
• DNACPR order applies solely to cardiopulmonary resuscitation and does not affect any other aspect of treatment

Patient admitted with community DNACPR order

• Review DNACPR status as soon as is clinically possible
• Community DNACPR remains valid until a consultant review is completed

Clinical justification

• Prolonging a patient’s life usually provides a health benefit to that patient
• A DNACPR order is ‘in the best interests of the patient’ if one or more of the following applies:
• patient is irreversibly close to death
• despite successful CPR, there would be an unacceptably high probability of death or severe brain damage
• length and quality of life after resuscitation are unlikely to be valued by patient
• patient, who is mentally competent, has expressed consistent desire not to be resuscitated

Ethics and consent

• Discuss DNACPR status with patient, if mentally competent, and/or family and carers
• in an emergency, document but discuss ASAP
• Follow consent process. See Consent guideline

Documentation

• Document the decision-making process at the time it happens in detail
• Once decision made, doctor (SpR or above) completes Trust DNACPR form.
• Once decision made, most senior nurse present must:
• write ‘not for cardiopulmonary resuscitation’ prominently in nursing record
• sign entry and write name and post in capitals
• Senior doctor and nurse inform the ward team

Review

• Doctor reviewing the DNACPR order documents and dates the review in the medical record

DNACPR decision rescinded

• Remove the DNACPR proforma from the patient’s medical notes and destroy
  • Senior nurse updates the nursing records and informs all other members of the healthcare team of the change in status

• If patient discharged from hospital with active DNACPR order, advise:
• the patient/carers
• the patient’s GP