Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Advance Care Planning :
Do Not Attempt Cardio-Pulmonary Resuscitation directive
Decisions about CPR may apply and be made in various settings including people’s homes, nursing homes, hospices, hospitals, and during transfer between settings.
It is emphasised that those decisions apply only to attempted CPR and do not imply that any other aspect of monitoring, care or
treatment will or will not be provided. All other appropriate care and treatment should be given.
Through the wording and implementation of their resuscitation policy, all healthcare organisations should therefore ensure:
1. effective recording of decisions about CPR in a form that is recognised and accepted by all those involved in the care of the patient
2. effective communication with and explanation of decisions about CPR to the patient, or clear documentation of reasons why that was impossible or inappropriate
3. effective communication with and explanation of decisions about CPR to the patient’s family, friends, other carers or other representatives, or clear documentation of reasons why that was impossible or inappropriate
4. effective communication of decisions about CPR among all healthcare workers and organisations involved with the care of the patient.
To facilitate this (and to facilitate clinical audit) it is recommended that decisions about CPR are recorded on a standard form that is used, recognised and accepted across geographical and organisational boundaries.
Because of differences in the law, in particular regarding capacity, different forms are available for use in England and Wales, and for use in Scotland.
Do Not Attempt Cardio-Pulmonary Resuscitation - England form
Template for the recording of a DNACPR decision in England
x min. Variable
Do Not Attempt Cardio-Pulmonary Resuscitation - Wales form
Template for the recording of a DNACPR decision in Wales
x min. Variable
Do Not Attempt Cardio-Pulmonary Resuscitation - Scotland form
Template for the recording of a DNACPR decision in Scotland
x min. Variable
The RC (UK) recognises increasing support for recording decisions about CPR in the context of wider planning, in which other care and treatment options are considered also, to identify and record those which the person would wish to receive as well as those that they would not want.
Such an approach is regarded by many patients and many healthcare professionals as more positive than a focus purely on whether or not CPR should be withheld in the event of cardiorespiratory arrest.
However the RC (UK) recognises that there are clinical circumstances in which CPR would provide no benefit, that in those circumstances CPR is therefore not a treatment ‘option’ for the patient, and that patients cannot demand treatment that is not indicated for their specific situation.
The RC (UK) recommends that :
• Paper forms on which CPR decisions are recorded should travel with the patient whenever possible.
• When a person is at home and has a current CPR decision (in particular a DNACPR decision) they understand and accept they should have with them a CPR decision form recording that situation.
• If healthcare organisations require copies of CPR decision forms for audit or records purposes it is recommended that each form is available in duplicate or triplicate with noncarbon copies that are a different colour and that have different printed wording to reflect
their purpose. Only the original (top) copy can then be identified as a CPR decision record for clinical use, avoiding the potential danger of a copy being used to guide clinical decisions when the original may have been cancelled.
• If CPR decision forms are completed and/or stored electronically:
a. they should contain all the required elements defined in this quality standard; they should be accessible immediately by all the organisations and individuals who may be involved in the person’s care;
b. there should be robust arrangements in place to ensure that they remain current and appropriate.
Decisions Relating to Cardiopulmonary Resuscitation
Guidance from the British Medical Association, The resuscitation Council (UK), and the Royal College of Nursing, 2014
view/access Pdf 598 KB
DNACPR Forms in the Community
Policy and Guidance from the Palliative Care and Implementation Board & RCGP Wales End-of-Life Care Working Group, 2015
view/access Pdf 2041 KB
DNACPR Integrated Adult Policy
Policy and Guidance from the NHS Scotland, 2010
view/access Pdf 1697 KB
This topic is part of the Advance Care Planning domain of the
Comprehensive Geriatric Assessment
Back To : Advance Care Planning
Advance Care Planning is one of 8 domains of the
Comprehensive Geriatric Assessment (CGA)
Back To : Comprehensive Geriatric Assessment