ChatterBank2 mins ago
"Do not resucitate" (DNR) laws.
20 Answers
I have concerns over my companies policy on "Do not resuscitate" (DNR) and "Do not Attempt Resuscitation" (DNAR) which could leave staff in a compromised legal difficulty.
I cant seem to find the "recent" relevant documentation online, especially in respect of the mentally incapacitated.
Any help please?
I cant seem to find the "recent" relevant documentation online, especially in respect of the mentally incapacitated.
Any help please?
Answers
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For more on marking an answer as the "Best Answer", please visit our FAQ.I'm still looking, but I found this http://www.sslmc.co.u...ance%20directives.pdf
this looks like a reasonable policy http://www.wirral.nhs...cy092010-27042011.pdf
It really does hinge on MCA competency, IMO
It really does hinge on MCA competency, IMO
Here are the MCA booklets, not sure where best to look for reference to DNR decisions but I hope this helps....
http://www.justice.go...apacity-act/index.htm
http://www.justice.go...apacity-act/index.htm
Ratter - I thought the relatives or next of kin to the mentally incapacitated person was the ones to make the decision. When my Mum first went into the first Care Home, I was asked this question within the first 15 minutes of her arrival. I did think it a tad quick off the mark and my answer was 'could she not get her coat off first'.....(:o(
I was also asked this question when my mentally disabled sister-in-law was dying of breast cancer in hospital.
I was also asked this question when my mentally disabled sister-in-law was dying of breast cancer in hospital.
Decision should be by a medical consultant after discussion with the patients family/significant others unless a properly signed and witnessed advance directive is in place. It should not be solely up to relatives as they could stand to benefit financially from the person's death.... its like the rules on consent.
Worth pointing out the term should really be 'do not attempt resuscitation' as outside a hospital setting where appropriate drugs/equipment are available it is far less successful and even if a heartbeat is restored inefficient CPR by less than well trained first aiders can leave the person brain- damaged or suffering other consequences of a long pause in circulation
Worth pointing out the term should really be 'do not attempt resuscitation' as outside a hospital setting where appropriate drugs/equipment are available it is far less successful and even if a heartbeat is restored inefficient CPR by less than well trained first aiders can leave the person brain- damaged or suffering other consequences of a long pause in circulation
When I worked in the hospice, the rule then was that if a person died in the ambulance, the ambulancemen HAD to attempt to resuscitate. If a patient was coming to the hospice to die, that was the one time when they were given instruction not to do that, but it had to be by a patient-specific exception, not a general rule.
This one looks like the policy itself is reviewed every two years http://www.northsomer...citation%20policy.pdf
ssection 5.5 appears to me to be of particular relevance
ssection 5.5 appears to me to be of particular relevance
The problem is, many of these residents never go into hospital, these are decisions being made in the care home where we care for them to the end, often GP's do not want anything to do with signing DNR forms, they just give us advice.
Our DNR authority forms pretty much just consist of:
Resucitate, yes or no
Reasons:
Signed by:
Date:
Our DNR authority forms pretty much just consist of:
Resucitate, yes or no
Reasons:
Signed by:
Date:
arggh Ratter, no wonder you want to do something about it.
IMO, and I am not an expert, at very least you want to document also who it was discussed with and a review schedule, either there should be regular resident reviews so everyone knows what is happening with each resident, or some kind of circumstance review so if someone has a serious infection for instance and is very very unwell, they might be DNAR while the illness is being treated, but if they recover and appear to be restored to their previous level of health, they might go back to a do attempt status.
IMO, and I am not an expert, at very least you want to document also who it was discussed with and a review schedule, either there should be regular resident reviews so everyone knows what is happening with each resident, or some kind of circumstance review so if someone has a serious infection for instance and is very very unwell, they might be DNAR while the illness is being treated, but if they recover and appear to be restored to their previous level of health, they might go back to a do attempt status.
Actually and second only after the residents, for the sake of the management too. Policy and implementation is THEIR responsibility and that is where the buck would stop if things went awry....maybe pointing that out might help?
It seems also that there is a tendency to say "Do not attempt rescitation" (DNAR) instead of resuscitate, to reflect how risky and not success guaranteed resuscitation is, especially where the person has multiple illnesses/problems and is not in a high tech environment.
It seems also that there is a tendency to say "Do not attempt rescitation" (DNAR) instead of resuscitate, to reflect how risky and not success guaranteed resuscitation is, especially where the person has multiple illnesses/problems and is not in a high tech environment.
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