THE ROWANS HOSPICE
CARDIOPULMONARY RESUSCITATION (CPR) POLICY AND PROCEDURE
POLICY STATEMENT
1. Cardiopulmonary Resuscitation (CPR) is an emergency treatment to maintain effective
circulation in the event of a cardiac or respiratory arrest.
2. CPR should not be attempted in clinical situations for which it is not an appropriate
treatment. At The Rowans Hospice an individual assessment is made in order to make a
decision about CPR for each patient in advance to avoid inappropriate resuscitation attempts
and ensure CPR is available where appropriate.
3. Where there has been no assessment and the patient does not have a signed DNACPR form
or valid Advance Decision to Refuse Treatment (ADRT) regarding CPR in place, then the
default position is to commence CPR
4. In all cases, and independent of the decision regarding CPR, every patient receiving services
from The Rowans Hospice will continue to receive the best quality specialist care and
treatment appropriate to their clinical condition.
5. A record of the decision regarding CPR will be recorded in the hospice clinical record for
those receiving inpatient, Day Centre or Heath Centre services.
6. The Rowans Hospice policy on CPR accords with the NHS South Central Unified Do Not
Attempt Cardiopulmonary Resuscitation (uDNACPR) Adult Policy introduced in 2010 and
revised in 2012
This policy on CPR applies to all who work within, visit or are treated within The Rowans Hospice.
This will include all patients attending The Heath Centre, Day Centre and/or admitted to the
inpatient ward; all those, paid and unpaid, working at; any visitor to staff or patients; and contractors
whilst on the premises and grounds of; The Rowans Hospice.
This policy has been updated to take account of regional and national guidelines and statutory
regulations and to comply with The Human Rights Act and Equality Act 2010.
Appendix 1 has a fuller account of the evidence on which the policy has been based.
DECISION-MAKING FRAMEWORK
In all cases, and independent of the decision regarding CPR, every patient receiving services from
The Rowans Hospice will continue to receive the best quality specialist care and treatment
appropriate to their clinical condition.
Finding a person dead in the absence of a valid DNACPR order
In the event of a clinician finding a person dead and there is no DNACPR decision or an
ADRT specifying refusal of CPR, the clinician must rapidly assess the case as to whether it is
appropriate to commence CPR. Consideration of the following will help to form a decision, but it
must be stressed that professional judgement that can be justified and later documented must be
exercised:
• What is the likely expected outcome of undertaking CPR?
• Is the undertaking of CPR contravening the Human Rights Act (1998) where the practice
could be inhuman and degrading because in the context it would not be successful?
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Providing the clinician has demonstrated a rational process in their decision making, the
employing organisation shall support the member of staff should this decision be challenged.
Assessment on admission to a hospice service
An assessment will be made by the multi-professional team taking account of the individual’s
condition and prognosis and likely outcome if CPR was attempted. This is in accordance with the
best practice in Advance Care Planning. Currently, legal responsibility for the decision rests with a
doctor.

For some their clinical condition will be too advanced and CPR will not be an appropriate
treatment. In such cases current guidance directs that it is not required to discuss CPR with
the patient and those close to them. Good practice would be to communicate the decision to
all parties.

For some a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision will form
part of an Advance Decision to Refuse Treatment (ADRT) in accordance with The Mental
Capacity Act (2005).
When the above do not apply:

Where no assessment or ADRT regarding CPR has been made the default position is to
commence CPR. See note above

Where the patient has capacity and does not have a DNACPR decision as part of an ADRT in
place and where, in the clinicians view successful resuscitation is a possibility, the benefits
and burdens of CPR in the context of their advanced disease will be discussed in a sensitive
manner with them and those close to them to allow them to make a decision to elect for or
not for resuscitation.
Where the decision is made to offer CPR this decision will be reviewed at the following
intervals
Ward
Weekly and again on discharge.
Day Centre At week 9 of the 12 week booked attendance period
Heath Centre At 6 weeks
to take account of changes in the patients clinical state or sooner if an event triggers an
earlier clinical review or if the patient requests a review.
It would be rare to review a decision not to attempt CPR.

Where the patient and those close to them continue to request CPR, and where the multiprofessional team assesses the treatment to be inappropriate to offer, and in the context of a
sensitive discussion, transfer to an alternative healthcare setting will be offered to allow them
to be managed by a team which is prepared to offer CPR.
COMMUNICATING THE DECISION
The decision to offer CPR is a professional decision made following a detailed assessment of the
patient’s condition and in the knowledge of the likely outcome from an attempt at CPR.
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For the majority of those receiving services at The Rowans Hospice their condition of an advanced
life shortening disease will determine they will neither suffer the circumstances that would lead to an
attempt at CPR nor respond to CPR if attempted. In this circumstances the patient would not always
be informed and if informed this will be done sensitively and preferably in the presence of those
close to them.
Where CPR is not to be offered and the decision is questioned by relatives or others, sensitive
communication will ensure they realise the decision is a professional clinical decision and not one
we are asking them to make.
For many, discussions regarding their view on CPR will have been had prior to attending The
Rowans Hospice. Where undertaken in accordance with NHS South Central’s Unified Do Not
Attempt Cardiopulmonary Resuscitation Adults Policy (uDNACPR), a completed uDNACPR form
(lilac-coloured) will be held by the patient. In these circumstances confirmation of the existence of
the form will be notes with the patient and those close to them.
Once made, the decision regarding CPR will be recorded on the Hospice’s own (white)
Resuscitation Status Form and placed on the inside cover of the patient’s hospice clinical record.
Copies of the form will follow the patient if referred to other services, for example, in-patient
referred to Day Centre etc.
Where the patient holds a uDNACPR form, the original lilac form or a copy will be taken from them
and placed in with The Hospice’s CPR decision form on the inside cover of the clinical record for
the duration of their inpatient stay. For The Heath Centre and Day Centre a copy of the form will be
held in the clinical record.
In addition to the above, written information regarding this policy regarding CPR is included in the
Patient Information Handbook which is given to patients and carers when admitted to the ward and
is available to those attending The Southwick Suite (Heath and Day Centres) on request. In addition
The Hospice Philosophy is on display and located in each inpatient ward room and in The Southwick
Suite.
The patient information leaflet providing information on CPR is available from staff and from the
ward display boards.
APPLICATION IN THE HOSPICE CLINICAL WORK AREAS
For Ward inpatients
The decision to attempt CPR or not will be determined by a doctor following assessment of the
patient at the time of admission, recorded on the Hospice’s CPR decision form and placed in the
front inside cover of the patient’s hospice clinical record.

Where a decision to attempt CPR has been agreed for a ward inpatient this decision will be
reviewed weekly to take account of changes in their clinical state or sooner if an event
triggers an earlier clinical review or if the patient requests a review. It would be rare to
review a decision not to attempt CPR.

It is important that this information is handed over at each shift. Any changes to the original
decision needs to be clearly documented, handed over to staff and discussed with the
patient/family.

Circumstances will arise where a patient not for CPR and without a completed uDNACPR
form will be discharged from The
Hospice. In such a case the uDNACPR
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form will be completed prior to discharge and the lilac form handed to the patient or their
carers. The ward clerk will ensure and ambulance service(s) are informed by fax according to
the uDNACPR policy at the time of booking of transport for discharge. The GP will be
informed that the patient holds a uDNACPR form in the discharge letter.

In some cases a patient without a uDNAPR decision or form will be agreeable to a
uDNACPR decision whilst in the hospital however will not accept a form on their return
home. In these circumstances a form cannot be given to the patient. By default the patient
will be for CPR in the event of a cardiopulmonary arrest either in the ambulance taking them
home or when at home. The letter to the GP will contain this information.
The Heath Centre and Day Centre (Southwick Suite)
For those attending The Heath Centre or Day Centre the assessment and decision to attempt CPR
will be made by the patient’s own GP unless the decision has previously been made and a lilac
uDNACPR form completed (for example following a hospital or hospice admission).

The respective manager will request the decision on CPR from the patient’s General
Practitioner as part of the assessment prior to attending the clinical service.

Where the decision is not to attempt resuscitation, and the patient does not hold a uDNACPR
form, the GP will be requested to complete a form and hand it to the patient. This decision
will be recorded on the Hospice’s CPR decision form and a copy of the uDNACPR form will
be taken and placed in the hospice clinical record.
 Where the general practitioner has communicated no decision and/or the patient does not
hold a completed uDNACPR form, the default position will be that the patient is for CPR.
 The respective manager will, for each day of attendance, provide the ward nurse co-ordinator
with a list of attending patients indicating the assessed appropriateness of CPR in each case.
This will ensure that the ward nurse co-ordinator is aware of the need for assistance in the
event of the need for CPR in the Southwick Suite.
Where a decision to attempt CPR has been agreed the decision will be reviewed as follows: 
Heath Centre – At 6 weeks or sooner if an event triggers an earlier clinical review or if the
patient requests a review.

Day Centre – At week 9 of the each 12 week booked attendance period or sooner if an event
triggers an earlier clinical review or if the patient requests a review.
Any changes to the original decision will be discussed with the patient and family and clearly
documented in the hospice clinical record and recorded on the hospice’s CPR form.
CPR AND AMBULANCE TRANSFERS TO AND FROM THE ROWANS HOSPICE
The default position of ambulance crews in the event of a cardio-respiratory arrest is to commence
CPR and to transport the patient to the nearest emergency department ("Accident and Emergency").
Admission
Where a uDNACPR form has been completed by the GP the ambulance service should have been
made aware of its existence. The form is held by the patient and can be shown to the ambulance
crew. The presence or not of the form will be
indicated on the admission request form. This can
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then be communicated to the ambulance service for those being transferred to The Rowans Hospice
from Home.
Discharge
Where the uDNACPR form has been completed prior to hospice admission the form will be handed
back to the patient and ambulance transport informed of the existence of the form.
For those being discharged who have not had a uDNACPR form completed prior to admission a lilac
form will be completed by a member of the medical staff prior to discharge and handed to the patient
if the patient has agreed to having a form. The doctor completing the form is responsible for faxing it
to the ambulance service, general practitioner and others as required (this task will be delegated to
the ward clerk). On booking transport for discharge the ward clerk will inform the service that the
patient will be holding a form. The discharge letter to the general practitioner will indicate that the
form exists and that a copy has been faxed for the GP record. A white copy of the completed form
will be kept in the file in the doctor’s office for reference and audit purposes.
On discharge the uDNACPR form is held by the patient and can be shown to the ambulance crew.
Where the patient has refused to have a form ambulance will be informed of this fact.
This statement will be signed by a doctor.
STAFF, VOLUNTEERS AND VISITORS TO THE HOSPICE
In the event of finding a member of staff, volunteer or visitor collapsed and in need of resuscitation,
CPR should be initiated unless it is clear that the person has expressed their views very clearly not to
be resuscitated; or is known to have an Advance Decision to Refuse Treatment specific to CPR; or
carries a valid DNACPR form. The appropriate "witnessed" or "unwitnessed" protocol should be
followed according to the circumstances of the discovery of the collapse.
TRAINING
All hospice staff that have therapeutic contact with patients will receive training in Adult Basic Life
Support as currently detailed by The Resuscitation Council, UK. This will be repeated every 12
months.
Medical staff will receive training in the completion of the uDNACPR forms.
PROCEDURE FOR IN-HOUSE CARDIOPULMONARY RESUSCITATION
General
All clinical staff will receive annual updates in Basic Life Support (BLS). Non-clinical staff will be
supported in accessing BLS training if they wish but an appropriate member of clinical staff should
always be involved in the event of a person collapsing on the premises.
Where CPR and basic life support are appropriate, the procedure will depend to some extent on the
setting (bedroom, meeting room etc) and time of day (level of staffing) however the actual conduct
of CPR follows UK Resuscitation Council Protocols.
All patients, whether for CPR or with a DNACPR status, should benefit from appropriate first aid
including attempts to clear an airway blockage if choking on food, or be positioned comfortably in
the event of collapse.
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THERE ARE TWO PROTOCOLS –
Protocol 1 – A witnessed collapse
Protocol 2 – An unwitnessed collapse.
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PROTOCOL 1: WITNESSED COLLAPSE (TWO PAGES)
In event of witnessing a collapse (regardless of CPR status*)
FIRST AID IS ALWAYS APPROPRIATE.
FIRST ON SCENE
1. Ensure environment is safe
2. Get help (pull cord / contact nearest office etc)
3. Establish situation (what kind of collapse, approx age of victim)
4. Administer First Aid if competent to do so (management of choking / recovery
position etc)
5. Await arrival of nurse coordinator
6. Do not leave until authorised to do so, the coordinator may require messengers
NURSE CO-ORDINATOR
1. Make clinical assessment
2. Direct clinical management accordingly
Respiratory or cardio-respiratory arrest
Non-arrest collapse
Basic Life Support if appropriate
Appropriate first aid
Inpatient for whom transfer is
inappropriate
Person for whom hospital
management is appropriate
Usual palliative care
Direct a responsible member of
staff to call an ambulance (999)
Complete transfer fax form and
ensure it is faxed
Arrival of paramedic crew
Ambulance crew arrives and takes over the clinical care
If a patient – all clinical notes to accompany patient in ambulance
Complete transfer form and fax to A&E
Contact NOK if known
Following the emergency situation
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Organise de-brief of those involved & arrange to follow up if appropriate.
Document the episode.
In most cases, informing the duty manager and medical consultant will be appropriate.
*For some people it will be known that a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)
decision is in place. This does not affect the decision to offer first aid to a collapsed or distressed
person until arrival of the nurse co-ordinator.
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PROTOCOL 2: UNWITNESSED COLLAPSE (TWO PAGES)
In event of finding someone unconscious (and in absence of a DNACPR decision*)
First on Scene
1. Ensure environment is safe
2. Get help (pull cord / contact nearest office etc)
3. Administer First Aid if competent to do so including CPR if trained
4. Await arrival of ward coordinator who will take over the management of the
situation
Second person to arrive
1. Establish situation (what kind of collapse, approx age of victim)
2. Call 999
3. In respiratory or cardiac arrest start CPR if competent
4. Do not leave until authorised to do so the coordinator may require messengers
*For some people it will be known that a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)
decision is in place. If this is known to the first or second person in attendance, CPR should not be
initiated: await arrival of the nurse co-ordinator.
Ward coordinator
1. Request defibrillator
2. Contact doctor
3. Make clinical assessment
4. Direct clinical management accordingly
5. Direct messengers to greet ambulance if appropriate and contact family if possible
6. Follow standard BLS protocol until told otherwise by doctor or ambulance crew
In unwitnessed collapse a doctor may assess as “too late to attempt CPR” and cancel the ambulance
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Respiratory or cardio-respiratory arrest
Non-arrest collapse
Basic Life Support if appropriate
Appropriate first aid
Inpatient for whom transfer is
inappropriate
Person for whom hospital
management is appropriate
Usual palliative care
Direct a responsible member of
staff to call an ambulance (999)
Complete transfer fax form and
ensure it is faxed
Arrival of paramedic crew
Ambulance crew arrives and takes over the clinical care
If a patient – all clinical notes to accompany patient in ambulance
Complete transfer form and fax to A&E
Contact NOK if known
Following emergency situation
Organise de-brief of those involved & arrange to follow up if appropriate.
Document the episode including the sequence of events, treatments and doses of
medications used in the attempt.
In most cases, informing the duty manager and medical consultant will be appropriate.
Produced July 02 Approved by EL/RS August 02
Reviewed and approved by Clinical Management Committee July2004
Addition June 2005 – recording on patient information sheet of patient’s knowledge of the policy
Addition Jan 2006 – statement for ambulance crew in event of cardiac arrest
Approved by PJM/HJ/JR/EL/RW and PN’s Jan 2006
Reviewed and approved by PJM/HJ/AR/NLJR/EL/RW/KMc/TJ and PN’s Feb 2008
Reviewed by PJM/HJ in conjunction with national guidance Oct 08 – Jan 09.
Reviewed by HJ/PJM in the light of a new strategic health authority policy April-June 2010
Approved by Clinical Management Committee July 2010/March 2011 (uDNACPR added). Reviewed
March/April in line with network unified policy. Nil changes in process. Approved April 2012.
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Appendix to CPR policy
The evidence to support the decisions regarding Cardiopulmonary resuscitation at The
Rowans Hospice
Background
Cardiopulmonary resuscitation (CPR) is a treatment originally introduced to support cardiac or
pulmonary arrest in accident victims to allow them to reach, and receive life saving treatments in
hospital. With the advancement of medical technology, and the ability to support those with more
chronic illness, CPR is now applied to all whose circulation or breathing ceases suddenly unless they
have expressed a wish for this not to occur.
CPR was never recommended for all patients, rather that its goal should be to ‘reverse premature
death’ in those with recoverable medical conditions rather than to ‘ prolong the terminal process’ in
those dying from advanced disease.
CPR is rarely indicated for patients who fulfil the criteria for ongoing specialist palliative care.
CPR comprises two phases
Basic CPR
Essentially the maintenance of circulatory and respiratory effort by simple artificial means which
can be carried out in any setting by someone who has been trained in the technique.
The simplest form would be ‘mouth to mouth’ and chest compressions applied by one or more
individuals to another. In some settings it might include simple defibrillation by an automated
external defibrillator (AED). This device allows the application of an electric counter shock to treat
the most common arrhythmias associated with cardiac arrest, Ventricular Fibrillation or Paroxysmal
Ventricular Tachycardia.
The goal of basic CPR is to maintain effective circulation to allow the brain and other tissues to
survive long enough for the person to be moved to a place where advanced CPR can be given.
Except in rare cases, and then more in respiratory arrest due to an obstructed airway, basic CPR
alone is insufficient.
Advanced CPR
The goal of advanced CPR is to maintain a satisfactory form of circulatory and respiratory effort to
allow the brain and other tissues to survive whilst the attempt is made to treat the underlying cause
of the arrest and re-establish the body’s maintenance of adequate circulatory and respiratory effort
for itself. It involves any number of supportive techniques, including pharmacological and
mechanical. Whilst some aspects of advanced CPR can be applied out of the acute hospital it is
accepted that this is an acute hospital treatment requiring highly skilled professionals with access to
advanced medication and technology. Many patients require intensive care following the
intervention.
Advanced CPR should only be commenced if there is a realistic chance of recovery from the insult
that precipitated the cardiorespiratory arrest.
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How successful is cardiopulmonary resuscitation?
Most people’s experience, of CPR is through the viewing of popular television medical dramas such
as ER, Casualty and others. Two thirds of the CPR attempts shown in these programmes involve
children or young adults, most are accident victims, and less than a third have a primary cardiac
cause. The success rate is 75% and two thirds live to leave hospital. In addition it is often portrayed
as a relatively clean and uncomplicated treatment. This is the popular expectation of CPR and is up
to 6 times more successful than reported in clinical studies where success rates of the treatment
range from 5 - 20%.
Some of the best evidence on the real life success rate for CPR comes from a hospital study in
Canada. This demonstrated that when CPR was applied to those with a witnessed cardiorespiratory
arrest half were able to be resuscitated, less than half of those survived to hospital discharge, and less
than one in 5 returned home. Survival was highest in respiratory arrest and lowest in cardiac arrest.
Of those patients with unwitnessed arrests one in five were able to be resuscitated and none who had
a cardiac arrest survived to be discharged from hospital. Few survive longer than 72 hours post CPR.
Many of those who do survive CPR are left with neurological disability.
Other evidence demonstrates CPR is least effective in those experiencing a cardiorespiratory arrest
in the presence of other serious and or life threatening illness including infection, kidney or heart
failure, other heart disease and advanced cancer. In those who are otherwise well with their cancer
their chances are similar to those without cancer. For those with advanced cancer and/or other illness
no-one survives to discharge following CPR. Age, does not appear to be a determinant of success,
rather it is the performance status of the individual that is important.
The poor success of CPR notwithstanding, it is a treatment associated with significant trauma. Post
mortem examination following unsuccessful CPR demonstrates that 30% have a fracture of the
sternum and 50% one or more rib fractures.
In those with advanced diseases it might be considered that the best possible outcome of CPR is that
the person’s state of health is returned to how it was in the period immediately before the
cardiopulmonary arrest occurred.
Ethical considerations
It is an accepted ethical and legal principle that a patient cannot make a demand for a treatment for
which there is evidence that it is either without benefit or the potential for harm caused by the
treatment outweighs its potential for benefit.
CPR as a treatment has deviated from this principle. In the absence of an advance decision to refuse
this form of treatment the presumption is that CPR will be undertaken in the event of a
cardiorespiratory arrest. Whilst this is reasonable to ensure an attempt at CPR in the absence any
medical history being available in a sudden collapse, it might be deemed unreasonable where the
person’s advanced, irreversible, life threatening disease is well known; where CPR may prolong or
increase suffering and subject the patient to a traumatic and undignified death.
An assessment of the benefits and harms of CPR must be made for all patients. A decision not to
offer resuscitation is permissible where the clinical team agrees CPR will not be successful and
would cause harm. The patient’s individual circumstances must be considered carefully before such
a decision is made. There is no obligation to discuss the decision in such circumstances. Outside
such circumstances discussion of the process and benefits and harms of CPR should be undertaken
with a patient who has capacity, preferably together with those close to them.
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National guidance and The Human Rights Act
The Human Rights Act, introduced in 1998, incorporates the majority of rights set out in the
European Convention on Human Rights into UK law. Any decision on CPR must demonstrate
compatibility with the human rights set out in the Articles of The Convention.
The relevant articles are:
 Article 2, the right to life;
 Article 3, the right to be free from inhuman or degrading treatment;
 Article 8, the respect for privacy and family life;
 Article 10, the right to freedom of expression, which includes the right to hold opinions and to
receive information;
 Article 14, the right to be free from discriminatory practices in respect to the rights within The
Act.
In 2002 The Royal College of Nursing, The Resuscitation Council and The British Medical
Association published a joint statement ‘Decisions Relating to Cardiopulmonary Resuscitation’
which was updated and published again in 2007. The document provides guidance on the making
and communicating decisions regarding CPR.
The joint statement contains the following guidance:
1. “Where no explicit decision has been made in advance there should be a presumption in favour
of CPR”.
2. “It is not necessary to initiate a discussion about CPR with a patient if there is no reason to
believe that a patient is likely to suffer a cardiorespiratory arrest”.
3. “If the clinical team believes that CPR will not restart the heart and maintain breathing, it should
not be offered or attempted”.
4. “Neither patients, nor those close to them, can demand treatment that is clinically inappropriate”.
5. “When a clinical decision is made that CPR should not be attempted because it will not be
successful, and the patient has not expressed a wish to discuss CPR, it is not necessary or
appropriate to initiate discussion with the patient to explore their wishes regarding CPR”.
6. “A Do Not Attempt Resuscitation (DNAR) decision does not override clinical judgment in the
unlikely event of a reversible cause of the patient’s respiratory or cardiac arrest that does not
match the circumstances envisaged”.
A joint statement by The Association of Palliative Medicine of Great Britain and Ireland, and the
National Council of Hospice and Specialist Palliative Care Services. ‘Ethical decision-making in
palliative care: Cardiopulmonary resuscitation (CPR) for people who are terminally ill’
The Palliative Care Statement considers CPR an appropriate option if all three of the following
conditions are met:
1. There is a reasonable chance of CPR re-establishing cardiopulmonary function.
2. Successful resuscitation would probably result in a quality of life acceptable to the patient.
3. It is the expressed wish of a patient with capacity to receive CPR in the event of a
cardiopulmonary arrest.
However, it also notes that:
1. For terminally ill patients (unambiguously defined as those with active and progressive disease
for whom curative treatment is not possible or not appropriate, and for whom death can
reasonably be expected within twelve months), the harms of CPR are likely to outweigh the
benefits. CPR is almost invariably unsuccessful in this patient group. The rare instances of
successful resuscitation typically result in
death from a further cardiopulmonary arrest
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before the patient can be discharged home.
2. There is no ethical obligation to discuss CPR with those palliative care patients for whom such
treatment is considered futile. It is recognised that this represents the majority of palliative care
patients. It can be potentially distressing for these patients if the subject of CPR is deliberately
raised with them, only to advise them that CPR attempts would almost certainly be futile.
3. Should a patient express a wish for CPR and it is considered likely that patient would benefit
from the procedure in the event of a cardiopulmonary arrest, the subject should be discussed
fully with the patient at the earliest opportunity. This discussion should ideally take place prior to
hospice admission and it should cover the extent of CPR facilities and the level of expertise
available in the hospice. The patient may still request admission to the hospice, accepting that
only limited and basic CPR is available and that emergency transfer to a hospital would be
arranged in the event of a cardiopulmonary arrest.
4. If no advance decision has been made by the patient about CPR then it is the doctor’s legal
responsibility to act in the patient’s best interests in the event of a Cardio-respiratory arrest as the
patient is by definition incompetent to make a decision at the time.
NHS South Central Unified Do Not Attempt Cardiopulmonary Resuscitation (uDNACPR)
Adult Policy
In March 2010 the South Central Strategic Health Authority introduced this policy with the
expectation that it will be adhered to by all healthcare organizations across the area it administrates.
The policy adheres to the national guidance (above) regarding the appropriateness of CPR and
DNACPR decisions in clinical situations. This policy was been updated in 2012.
The policy introduces a new form on which a decision for DNACPR is recorded. The intention is
that the patient should have the DNACPR form available at all times and carry it with them when
being transported by ambulance. Also that on admission to hospital or hospice they should indicate
they have the form.
The form was originally available in a triplicate carbon package, and electronically for printing.
With the dissolution of NHS South Central there is no programme for the continuation of the carbon
package to all units. Some Trusts, and Portsmouth Hospitals Trust is one, have their own triplicate
carbon packages that they continue to use. The current version, version 6 and with the word
‘informed’ in section 1a of the form is available as an electronic copy. The Rowans Hospice has
elected to print the form on lilac paper in readiness for its completion.
The lilac-coloured, top copy of the ‘carbon’ package is to be retained by the patient, with a tear off
slip attached to place in a ‘message in a bottle’. The bottom, white copy should be retained in the
patients clinical record where it has been completed.
If printed from the digital copy, the copy given to the patient must be printed on lilac coloured paper.
Two white copy should be retained, one in the patient’s clinical record, the other in the green
DNACPR file in the doctors’ office for audit purposes.
What of those working at, visiting or using the services offered at, The Rowans Hospice?
For those working at or visiting The Rowans Hospice the presumption should be that they are for
CPR.
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For patients, the benefits and burdens of attempting CPR should be assessed for all whether they are
attending The Heath Centre, Day Centre or are inpatients on the ward.
In general those attending the Heath Centre will have a performance status better than those
attending the Day Centre who in turn will generally have a performance status better than inpatients.
Those admitted as inpatients on the ward will, on average, be those with the most advanced disease.
Some will have made An Advance Decision to Refuse Treatment (ADRT) which may include their
decision on CPR. Others will, following assessment, be considered inappropriate to offer an attempt
at CPR. For the remainder their assessment will require a discussion of the benefits and burdens of
CPR in the context of their disease state and performance status. For most this discussion will agree
CPR is not appropriate, for some the discussion will agree CPR should be attempted in the event of a
cardiorespiratory arrest whilst they are at The Rowans Hospice.
Supporting Evidence
Unified Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Adult Policy
South Central Strategic Health Authority, 2012
Advance Decisions to Refuse Treatment, a guide for health and social care professionals. London:
Department of Health http://www.ncpc.org.uk/download/publications/ADRT.pdf
Human Rights Act. (1998) London: Crown Copyright.
http://www.opsi.gov.uk/acts/acts1998/ukpga_19980042_en_1
Mental Capacity Act. (2005) London: Crown Copyright.
http://www.opsi.gov.uk/acts/acts2005/ukpga_20050009_en_1
NHS End of Life Care Programme & the National Council for Palliative Care (2008)
Resuscitation Council UK (2007) Decisions relating to cardiopulmonary resuscitation; a joint
statement from the British Medical Association, the Resuscitation Council (UK) and the Royal
College of Nursing. RC (UK) http://www.resus.org.uk/pages/dnar.pdf
Royal College of Physicians (2009) Advance Care Planning. London: Royal College of Physicians
http://www.rcplondon.ac.uk/pubs/contents/9c95f6ea-c57e-4db8-bd98-fc12ba31c8fe.pdf
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Resuscitation policy and procedure
Revision No.
Approved by: HJ/PJM/SP/CMM
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Date of Approval:
Dateby:
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Implementation:
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April 2014