"Do not resucitate" (DNR) laws.

[RATTER15]

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?

[boxtops]

I'm still looking, but I found this http://www.sslmc.co.u...ance%20directives.pdf

[boxtops]

and this http://www.rlb-law.co...licies-(apr-2006).pdf

[boxtops]

this looks like a reasonable policy http://www.wirral.nhs...cy092010-27042011.pdf

It really does hinge on MCA competency, IMO

[boxtops]

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

[RATTER15]

Thanks very much Boxtops, A lot of very useful material there. I just need to re-write our DNR policy and see if I can get my directors to accept it.

Many thanks xxx

[DEN53]

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.

[rowanwitch]

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

[seadogg]

Which is why all rescue organisations train carefully on this one. Rowan.

[boxtops]

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.

[seadogg]

Most frustrating one for us was people who are actually trying to commit suicide, you still have to do what you can to save them , including CPR .

[RATTER15]

Thanks for all your answers.

Is there a legal requirement in how often the DNR consent needs to be reviewed?

[boxtops]

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

[boxtops]

^^ PS I can't see anything in there about reviewing the decision about an individual patient though - looks like once the decision is made by patient or MCA appointed person, it stays on record, but I may be wrong on that.

[woofgang]

When i worked in the NHS, the decision was supposed to be reviewed on every hospital admission...but I don't think that was law, just policy.

[rowanwitch]

The guideline is often 'whenever there is a significant change in a patients condition'... this allows for things like exceptional responses to radical treatments..the decisions probably are not reviewed often enough so on each admission is probably the minimum in an ideal world

[RATTER15]

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:

[woofgang]

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.

[RATTER15]

Woofgang, we have incredibly detailed care plans and updated very regularly, I am however struggling to get my Manager to recognise the importance of these DNR authorisation forms and how we need to get them written out correctly, for the sake of our residents and the staff.

[woofgang]

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.

[RATTER15]

Thanks for you informative response Woofgang and the rest of you, very helpful.