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May 1, 2020

Demi’s Palliative Care Blog: What is a DNACPR?

What is a DNACPR?

With Demi Brooks

This week, I want to discuss one of the decisions you can make regarding whether you would want to be resuscitated in an emergency.  

This is called a DNACPR (Do Not Attempt Cardio – Pulmonary Resuscitation), which is a document where you can record the decision that you do not want to be resuscitated in an emergency. This can be used as part of yours or your loved ones Advance Care Plan (See last week’s blog which explains what an Advance Care Plan is here).

What is a DNACPR?

DNACPR is a decision that is made in advance by an individual and is often put in place to prevent healthcare professionals from attempting CPR (Cardiopulmonary – Resuscitation) against the individuals wishes, as this would not be appropriate for the person if they were to have a cardiac arrest or stop breathing.

The actual document records this decision and can provide immediate guidance to healthcare professionals, across all settings, of the individuals wishes in an emergency.

These decisions can be made by a doctor or put in place by an individual as part of their Advance Care Plan. It is important to note that they are not legally binding.

Deciding on whether to have CPR is a big decision to make.

Not everyone wants to receive CPR, so a DNACPR document gives clear guidance on an individual’s decision.

Often, many individuals choose not to be resuscitated due to an underlying condition; this could be a palliative or end of life diagnosis, or an advanced condition.

All of us will have seen medical drama television shows, such as Casualty, where often CPR is performed on an individual, with only a couple of chest thrusts, and next thing you know the patient is sat in bed with a cup of tea.

In real life, CPR is not like television. Often, it can be a physically vigorous intervention.

If an individual does not have the capacity to discuss this decision, it may be made with a close family member and healthcare professionals. If you find yourself in this situation, it can be difficult to discuss this. However, it is important to listen to healthcare professionals advice, whilst thinking what is best for your loved one, enabling you to make an informed decision.

Just like with advance care planning, it is important to have these conversations with your loved ones, especially if they have a palliative or end of life diagnosis. That way they can make those choices, record them and use them alongside their Advance Care Plan.

How does a DNACPR work?

A DNACPR decision may be made and recorded

  • At the request of the person themselves
  • As a shared decision (made by the person themselves and their doctor)
  • By the healthcare team, when a patient has a long-term condition or is dying, and CPR would not prevent death
  • By the healthcare team, if the person is not able to make that decision, and a decision has been made in their best interest
  • If someone is unconscious and very unwell, a Doctor will have a conversation with a relative and consider information from them.

When Doctors are considering making a DNACPR recommendation, there is a legal requirement for them to discuss this with the patient, or if unable to do so with the patient, then those close to the patient.

Family members are not expected to make decisions regarding CPR, unless they have been given legal power of attorney.

When having these discussions with doctors about my loved one, it was hard, but because my loved one was dying, I knew CPR would not have been effective and would have put him through something unnecessary that wouldn’t have changed his outcome.

Remember it is important to have these conversations with loved ones, especially during Covid-19, so that you can make sure these decisions are in place.  You can contact your doctor or health professionals involved in yours or your loved one’s care and get this decision recorded.

Next week in my blog I will be discussing ReSPECT, a new document that has recently been launched in Norfolk and Waveney that will eventually replace the DNACP form.

Stay safe.

Demi Brooks is the Palliative Care Education Co-ordinator for Big C.

Reference: Information taken from Royal College of Nursing (RCN) 2020 and Resuscitation Council 2020.

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