The policy provides a framework to ensure:
the patient's wishes are respected
decisions reflect the best interest of the individual and benefits are not outweighed by burdens
a DNACPR decision is clearly recorded and communicated between health professionals.
The policy and its algorithm are designed to ensure that the individual and/or those closest to them are involved in a DNACPR decision.
Integral to this policy is a standardised, unified form to record adult DNACPR decisions, which aims to improve communication between healthcare staff across all care settings, avoiding inappropriate CPR attempts at the end of life.
The concept of a ‘Natural Anticipated and Accepted Death’ has been included for less acute situations when death might be considered clinically inevitable.
This trigger for end of life discussions with the patient and/or family should allow a DNACPR position to be clarified.
This would in no way alter any other aspect of achieving optimal care as DNACPR decisions refer only to CPR, not to any other aspect of the individual's care or treatment.
As the new form is implemented, it will run concurrently with other DNACPR forms whilst these are phased out.
All new DNACPR decisions, however, will be recorded on the All Wales DNACPR form from 1 October 2015. Older versions of the form remain valid, but can be reviewed and renewed as appropriate.
This ‘live’ policy will be adjusted to changes in clinical or legal circumstances as they emerge.