DNAR

Policy, Practice and Challenges

'Do not resuscitate': Ide’s plea for

wishes to be respected. 80 year old

woman's fear of being "hammered to

hell" by paramedics is terrifying her in

her final years. ‘I want to be a happy

camper when I leave this world’

Irish Examiner

Think About

Are there times when I know resuscitation

or attempted resuscitation shouldn’t have

happened but it did?

Have I ever discussed DNAR with a

resident?

What needs to happen in my nursing

home/hospital?

Guidance/Policies:

• National Consent Policy 2012 - Part 4 – DNAR

Other Guidance

• Medical Council Guidelines

• An Bord Altranais

• Local policies

Pending

• National Policy On Do‐not‐attempt‐resuscitation

Decisions

28/11/2013 National Consent Policy

National Consent Policy (HSE)

• Provides a decision-making framework to facilitate

advance discussion of personal preferences

regarding CPR and DNAR orders

• Aims to ensure decisions are made consistently,

transparently and in line with best practise

28/8/2013 National Consent Policy

General Principles

• Individual decision-making

• Involving individuals in discussions

• Involving family & friends in discussions

• Decision-making capacity

• Provision of information

• Decision-making regarding CPR & DNAR orders

28/11/2013 National Consent Policy

Terminology : What do we mean by…

DNAR: Do Not Attempt Resuscitation (CPR)

CPR: Cardiopulmonary Resuscitation includes chest

compressions, defibrillation, the injection of drugs &

ventilation of lungs

28/11/2013 National Consent Policy

Cardiopulmonary Resuscitation

• Intervention for treatment of cardiorespiratory arrest

• Survival rates:

• In hospital: 13-20%

• Out of hospital: lower again

• Includes:

• Chest compressions

• Defibrillation

• Medication

• Ventilation

Why should we talk about DNAR?

• Fits with the practice of good care planning

• Having conversations about DNAR and future care

provision results in better care at end of life.

• Protects the patient from unnecessary and

inappropriate interventions

• In keeping with individuals right to refuse (ADMCA

2015)

• Avoids ‘slow coding’ and ‘sham resuscitation’

• Prevents confusion and unnecessary distress to

families

Talkcpr clip

National Consent Policy

Individual decision-making

• Individual assessment of each case

• Individual's own views and values are central

• Balance benefits and risks involved in CPR and likelihood of

success

• Likely clinical outcome

• Likelihood of successfully restarting heart and breathing

for a sustained period

• Level of recovery that can be reasonably expected

Involving Family

• If the person wishes..

• If the person wants…

• If the person can’t participate…

•Find out from those who know the person best about any

previously expressed preferences wishes and beliefs.

•From their knowledge of the person ,what do they think the

person would want.. This does not mean that they make

the choice or decision.

The final decision regarding DNAR lies with the most senior

healthcare professional

Let’s discuss

1. Are there residents currently in my care who would

benefit from this conversation?

2. Are there residents in my care who cannot engage

in this conversation but for whom this decision

should be made?

3. What, if anything, is needed in my nursing

home/hospital to enhance practice in this area?

Talking about dying

• http://www.sad.scot.nhs.uk/video-wall/

Cheers!