carers and close relatives and occasionally by the patient him/herself. These are the common clinical scenarios when a DNACPR position might initially be considered. Audit point 3 - A team discussion on DNACPR The possibility of a cardiac arrest and death of a patient should lead to a team discussion relating to DNACPR - with an additional community perspective whenever possible. The clinical decision framework (page 9) may be a helpful guide. A decision to proceed to a DNACPR discussion with the patient should be recorded. The DNACPR discussion itself should take place as soon as possible thereafter (within 12 hours). 5.2 a] If CPR will not restart the patient’s heart and maintain breathing If the clinical team is as clinically certain as it can be that attempting CPR would not re-establish effective circulation and maintain breathing then CPR need not be attempted. To provide CPR in such circumstances would be futile. The decision is a clinical one centred on the clinical picture at the time b] If the potential effects” of CPR outweigh any potential benefits “adverse Even if CPR might possibly restore circulation, the benefits of prolonging life must be balanced against any risk of harm, pain, discomfort or stress to the patient. The patient’s recently expressed wishes are clearly very important in such situations. If the patient’s wishes are not known they will by now of course lack the capacity to engage in the decision and the team should consider whether a natural death free from the invasive intervention of CPR may be in the patients’ best interests. In either situation this may result in a Natural Anticipated and Accepted Death (NAAD). point 4 Consider possibility of and DNACPR” – “NAAD When reviewing a patient’s position all salient aspects must be taken into account and shared with the patient to reach a clinically informed decision. It may be possible to conclude that the situation should be managed as a Natural Anticipated and Accepted Death (NAAD). NAAD is a concept” which might help clinicians and patients in partnership to reach a common “clinical position from which a DNACPR follows. FRAMEWORK FOR DNACPR DISCUSSION T c
carers and close relatives and occasionally by the patient him/herself. These are the common clinical scenarios when a DNACPR position might initially be considered. Audit point 3 - A team discussion on DNACPR The possibility of a cardiac arrest and death of a patient should lead to a team discussion relating to DNACPR - with an additional community perspective whenever possible. The clinical decision framework (page 9) may be a helpful guide. A decision to proceed to a DNACPR discussion with the patient should be recorded. The DNACPR discussion itself should take place as soon as possible thereafter (within 12 hours). 5.2 a] If CPR will not restart the patient’s heart and maintain breathing If the clinical team is as clinically certain as it can be that attempting CPR would not re-establish effective circulation and maintain breathing then CPR need not be attempted. To provide CPR in such circumstances would be futile. The decision is a clinical one centred on the clinical picture at the time b] If the potential “adverse effects” of CPR outweigh any potential benefits Even if CPR might possibly restore circulation, the benefits of prolonging life must be balanced against any risk of harm, pain, discomfort or stress to the patient. The patient’s recently expressed wishes are clearly very important in such situations. If the patient’s wishes are not known they will by now of course lack the capacity to engage in the decision and the team should consider whether a natural death free from the invasive intervention of CPR may be in the patients’ best interests. In either situation this may result in a Natural Anticipated and Accepted Death (NAAD). point 4 – Consider possibility of “NAAD and DNACPR” When reviewing a patient’s position all salient aspects must be taken into account and shared with the patient to reach a clinically informed decision. It may be possible to conclude that the situation should be managed as a Natural Anticipated and Accepted Death (NAAD). NAAD is a “clinical concept” which might help clinicians and patients in partnership to reach a common position from which a DNACPR follows. FRAMEWORK FOR DNACPR DISCUSSION T c
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