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Registration Number: {{org_field_registration_no}}

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Resuscitation and DNAR (Do Not Attempt Resuscitation) Policy

1. Purpose The purpose of this policy is to provide clear guidance on the decision-making process and implementation of resuscitation and Do Not Attempt Resuscitation (DNAR) orders within {{org_field_name}}. This policy ensures compliance with:

• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
• Mental Capacity Act 2005
• The Resuscitation Council UK Guidelines
• CQC Requirements on End of Life Care
• National Framework for Advance Care Planning This policy aims to ensure that resuscitation decisions are made in a person-centred, lawful, and ethically sound manner, ensuring the dignity and rights of the people we support are upheld.

2. Scope This policy applies to:

• All employees, including care staff, nurses, and senior managers.
• General practitioners (GPs) and other healthcare professionals involved in care planning.
• People we support and their families, advocates, and legal representatives.
• External healthcare providers and emergency services liaising with {{org_field_name}} regarding resuscitation decisions.

3. Policy Statement {{org_field_name}} is committed to ensuring that:

• Resuscitation decisions are made based on clinical need, individual preferences, and legal considerations.
• Every individual has the right to be involved in decisions about their resuscitation status, except where they lack mental capacity.
• A DNAR decision is never made solely based on age, disability, or perceived quality of life.
• All staff are trained and competent in resuscitation procedures and DNAR processes.
• Documentation regarding resuscitation status is clear, accessible, and respected.
• DNAR decisions are reviewed regularly and in response to changes in health status.
• All actions comply with CQC’s Fundamental Standards of Care.

4. Decision-Making Process

4.1 Person-Centred Approach

• The person we support has the right to make decisions about their own care, including resuscitation preferences.
• If a person lacks capacity, decisions must be made following the Mental Capacity Act 2005, ensuring the involvement of family, advocates, or legal representatives.
• DNAR discussions should be sensitive, clear, and documented, ensuring that individuals understand their options and implications.

4.2 Clinical Judgement and Legal Considerations

• A DNAR decision must be made by a senior clinician (usually the person’s GP or consultant).
• If a DNAR decision is made on clinical grounds, it must be clearly documented with the rationale and supporting evidence.
• In an emergency, if there is no DNAR decision recorded, the default response is to attempt resuscitation unless doing so would be clinically inappropriate.

4.3 Mental Capacity and Best Interests

• If a person lacks mental capacity, a best interest meeting must be held involving:
  • The care home staff
  • The GP or relevant clinician
  • Family members or advocates
  • If applicable, the person’s Lasting Power of Attorney (LPA) for Health and Welfare
• Decisions must be made in line with the Mental Capacity Act 2005 and recorded appropriately.

5. DNAR Documentation and Communication

5.1 Recording DNAR Decisions

• DNAR decisions must be documented on the appropriate DNAR form, signed by a qualified healthcare professional.
• A copy of the DNAR form must be kept:
  • In the care plan of the person we support.
  • In a clearly marked DNAR folder accessible to emergency services.
  • With the GP or clinical lead responsible for the decision.

5.2 Reviewing DNAR Decisions

• DNAR decisions must be reviewed regularly (at least annually) or when:
  • The individual’s health condition changes significantly.
  • The person or their legal representative requests a review.
  • A clinician deems it necessary based on medical changes.

5.3 Communicating DNAR Decisions

• All care staff and nurses must be aware of DNAR orders and where they are stored.
• DNAR decisions must be communicated effectively to emergency responders.
• If a DNAR decision exists, but emergency services are called, staff must present the DNAR form immediately.

6. Emergency Resuscitation Protocol

6.1 Responding to a Cardiac Arrest

• If a DNAR order is NOT in place, Basic Life Support (BLS) must be commenced immediately.
• If a DNAR order exists, staff must respect the decision and provide appropriate comfort care.
• Only staff trained in CPR and resuscitation should perform resuscitation attempts.
• Staff must call 999 immediately and provide full details, including the resuscitation status of the individual.

6.2 Staff Training and Competency

• All staff must complete annual training in CPR and DNAR awareness.
• Training includes:
  • How to recognise cardiac arrest
  • How to initiate CPR (if applicable)
  • Understanding DNAR decisions
  • Legal and ethical considerations in end-of-life care
• Competency checks must be carried out annually, and refresher training will be provided as required.

7. Safeguarding and Ethical Considerations

• DNAR decisions must not be made based on assumptions regarding disability, age, or quality of life.
• Safeguarding concerns must be reported if a DNAR decision appears to be made without proper consultation.
• The Registered Manager will review all DNAR-related complaints and concerns in line with Regulation 16 – Receiving and Acting on Complaints.

8. Policy Review This policy will be reviewed annually or earlier if:

• Legislation or CQC guidance changes.
• Significant concerns arise regarding DNAR decisions.
• Audit findings indicate a need for improvement.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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