The law states that if a clinical decision is made about DNACPR this must be explained to the patient. If the patient lacks capacity, the decision must be explained to their relatives.
DNACPR forms and CPR decisions
DNACPR (do not attempt cardiopulmonary resuscitation) forms protect patients from being given CPR inappropriately.
Some patients and relatives are confused about how DNACPR decisions are made. It is important that any decision made about DNACPR is communicated properly to reduce the risk of conflict between doctors, patients and their families.
Important
If you have a patient who does not want CPR you should record this in a DNACPR form, and they should also make an advance directive (also known as a living will or advance decision).
This page is for healthcare professionals. We also have specific information for the public.
To order DNACPR forms contact your local integrated care system (ICS).
Talking to patients about DNACPR
When making a decision about DNACPR, it is important for the patient and clinician to have a shared understanding of:
- the patient’s diagnosis, prognosis and current situation
- what outcomes the patient would value and fear
- what treatments might help to achieve their desired outcomes
Example conversation with a patient
Open the conversation
- I’d like to talk with you and do some planning so we’d know what steps to take if you get more sick. Would that be okay?
Assess the patient’s perspective
- What is your understanding of your health?
- What are your worries?
- If time were short, what would be most important to you? What else?
Share your view with the patient
- What we know about your health is . . .
- Would it be okay if I told you what I think about using CPR given your health? What do you know about this already?
- When a patient’s health declines to the point that the heart stops working, the medical team sometimes uses CPR to try to restart the heart.
- Given your current health, our team is worried that using CPR might do more harm than good. It is unlikely to help you to live longer or to have a better quality of life.
Align
- I imagine this is hard to think about. What are your thoughts?
- Would you like some time to think about what we’ve discussed and talk to you relatives/friends?
Make a recommendation
- I recommend that we make a plan to help you meet your goals and avoid treatments that are unlikely to help.
- Our plan to help you meet your goals is . . .
- I recommend that if your heart were to stop working, we focus on your comfort. This means having treatments such as oxygen and medication. This also means we would not use CPR. Does this plan sound okay to you?
Respond to the patient
- If the patient does not agree: I understand, but you should be aware that I have added a DNACPR form to your medical records. This means if your heart stopped working, our plan would be to keep you comfortable.
- If the patient agrees: Okay. I think this makes sense for you. If your heart stopped working, our plan would be to keep you comfortable.
Document your conversations
- Any decisions made about treatment which are recorded in a DNACPR form should be added to the patient’s medical notes and shared with the wider clinical team.
It’s important to be prepared for these conversations and to not put them off.
If a patient does not want to discuss DNACPR they do not have to. But you must tell them if a clinical decision has been made that CPR is not appropriate and a DNACPR form has been added to their records.The only exception is if you think telling the patient about the DNACPR decision would cause them physical or psychological harm. If the patient lacks capacity, the decision must be explained to their relatives.
If a patient or their relative does not agree with the clinical decision about CPR a second opinion should be offered, unless the decision was made by all members of a multidisciplinary team.
Important
The law states that if a clinical decision is made about DNACPR this must be explained to the patient. If the patient lacks capacity, the decision must be explained to their relatives.
DNACPR decisions must always be based on the health and priorities of each individual patient. There must not be blanket policies that apply DNACPR decisions to groups of people.
Recording DNACPR decisions
Decisions about CPR are recorded in different ways. Depending on where you are in the country you might use:
- DNACPR
- ReSPECT process
- Treatment Escalation Plan (TEP)
- Urgent Care Plan
- Great North Care Record
To order DNACPR forms, or to find out what is used in your area contact your local integrated care system (ICS).
Sharing the decision
Once the decision about CPR is recorded, it must then be added to the patient’s medical notes and shared with the wider clinical team. This may include the:
- out of hours team
- local hospital
- local ambulance trust
- GP
Any clinical decision made about DNACPR must also be communicated to the patient. If the patient lacks capacity, the decision must be explained to their relatives.
Reviewing DNACPR decisions
Decisions about DNACPR should be reviewed when appropriate, particularly if the patient’s health or wishes have changed. For example, when a DNACPR decision is made for a critically ill patient a review and cancellation might be needed if they respond well to treatment. However, in cases of severe chronic health conditions or a palliative care setting frequent review of the DNACPR decision might not be necessary for patients. If it is unclear whether a review is needed check with a senior doctor.
For more information on when DNACPR decisions should be reviewed see page 30 of the joint guidance on decisions relating to CPR (PDF, 582KB) from the British Medical Association, Resuscitation Council UK and the Royal College of Nursing.
DNACPR decisions in different care settings
DNACPR decisions are recorded in different ways, which means there may be different forms used within one area.
In many areas it is policy for a DNACPR form to travel with a patient if they move between settings, so it is important that staff in all care settings are familiar with the form.
If you are not sure what form your patient should have contact your local integrated care system (ICS).
Signing DNACPR forms
A DNACPR form must be completed and signed by a doctor. In some NHS Trusts a senior nurse can also complete and sign a DNACPR form, you can check your local resuscitation policy for guidance.
Do not ask patients or relatives to co-sign the DNACPR from. This can lead people to think they are being asked to decide about CPR which often leads to confusion.
For more information about signing the form see page 28 of the joint guidance on decisions relating to CPR (PDF, 582KB) from the British Medical Association, Resuscitation Council UK and the Royal College of Nursing.