NHS Scotland has a ‘do not attempt cardiopulmonary resuscitation: integrated adult policy’.

This policy aims to prevent inappropriate, futile or unwanted attempts at CPR which may cause significant distress to patients and families. It provides a decision-making framework which supports the appropriate use of the national DNACPR form.

The policy applies to all NHS Scotland staff and the care of adult patients in all care settings within the remit of NHS Scotland. Independent care organisations and facilities are also encouraged to make use of the policy for the benefit of their patients.

Key principles outlined in this policy include:

  • The circumstances of cardiopulmonary arrest must be anticipated
  • When CPR would fail it should not be offered as a treatment option
  • Appropriate and sensitive communication and the provision of information are an essential part of good patient care
  • Decisions made, information shared and with whom should be recorded in the case-record
  • Quality of life judgements should not be part of the decision-making process for healthcare professionals
  • Where no advance decision about CPR has been made there should be an initial presumption in favour of providing CPR
  • The presence or absence of a form should not override clinical judgement about what would be beneficial to a patient in an emergency e.g. choking, anaphylaxis, sepsis
  • Decisions recorded on the national form should be shared with all care providers, including at time of transfer to and from home or hospital. The form should be readily visible in case-files and transferred with the patient. (When the patient is going home, such document sharing should only occur where relevant others already know of the decision)
  • There should be a clear and appropriate time-frame for the review of the decision based on the patient’s clinical condition. If the decision is reversed the form should be scored through in black ink and the word ‘reversed’ written across it.

View the full Adult policy (Aug 2016) 

View the decision making framework (Aug 2016)

View the DNACPR Fact Sheet for patients and families (Aug 2016)

View the NHSScotland DNACPR Form (Aug 2016)

View the Joint Statement from the BMA Resus Council

Do Not Attempt Cardiopulmonary Resuscitation NHS Scotland Policy and Clinical Practice - video

This training video aims to enhance your awareness of the NHSScotland Do Not Attempt Cardiopulmonary Resuscitation policy, its decision-making framework and some key communication issues. At the end of the video you should feel confident in knowing when and how to make such decisions with your patients and when and how discussions around these decisions can be approached. You should also have an understanding of how this policy can be embedded within your own clinical practice.

A transcript of this video can be found at this link.

ReSPECT

The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a UK initiative to support anticipatory care planning (ACP) and the ACP process. 

The ReSPECT process is intended to encourage good conversations around anticipatory planning and a shared understanding of realistic treatment options and the aims of care more generally.  The process respects both patients’ preferences and clinical judgement for emergency care situations. 

Read more here.

Supporting Families around the Resuscitation of an Adult Family Member

A person’s sudden collapse is potentially one of the most traumatic events that a family can experience, particularly when unexpected and if the resuscitation is not successful. This video aims to help prepare healthcare professionals to support and communicate with families at this difficult time. Please note that this video is designed to act as a guide to communication and the depictions of cardiopulmonary resuscitation used within it should not be considered instructional.

A transcript of this video can be found here.

A downloadable leaflet which accompanies the video can be found here