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Registration Number: {{org_field_registration_no}}

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Resuscitation and Do Not Attempt Resuscitation (DNAR) Policy

1. Purpose

The purpose of this policy is to establish clear guidelines on resuscitation and Do Not Attempt Resuscitation (DNAR) decisions within {{org_field_name}}, ensuring compliance with Care Inspectorate Wales (CIW) regulations, the Mental Capacity Act 2005, the Regulation and Inspection of Social Care (Wales) Act 2016, and guidance from the Resuscitation Council UK. This policy ensures that resuscitation decisions are made in accordance with legal and ethical standards, safeguarding residents’ rights and maintaining dignity in end-of-life care.

2. Scope

This policy applies to all employees of {{org_field_name}}, including nurses, healthcare assistants, care staff, and management. It covers the process for making, recording, and implementing DNAR decisions, the role of advanced care planning, staff responsibilities, training requirements, and the management of emergency situations. This policy ensures that DNAR decisions are person-centred and legally compliant while balancing clinical best practices.

3. Related Policies

This policy should be read alongside:

• CHW38 – End of Life and Palliative Care Policy: Ensuring dignity in end-of-life care planning.
• CHW07 – Person-Centred Care Policy: Respecting individual preferences and choices.
• CHW39 – Mental Capacity and Deprivation of Liberty Safeguards Policy: Supporting legal compliance in decision-making.
• CHW36 – Communication and Engagement with Service Users and Families Policy: Ensuring open discussions with families regarding DNAR decisions.
• CHW11 – Safe Care and Treatment Policy: Maintaining appropriate clinical responses in emergencies.

4. Policy Statement

{{org_field_name}} is committed to ensuring that all DNAR and resuscitation decisions are made with dignity, compassion, and legal compliance. We recognise that cardiopulmonary resuscitation (CPR) may not always be appropriate for every resident and that DNAR decisions should be based on clinical judgement, the individual’s wishes, and ethical considerations. This policy ensures that all DNAR decisions are documented, communicated, and respected while providing person-centred care.

5. Decision-Making Process for DNAR Orders

All DNAR decisions must be based on medical, ethical, and legal considerations:

• Clinical Assessment: DNAR decisions should be made by a GP or senior medical professional in consultation with the resident and their family where appropriate.
• Resident Involvement: If a resident has mental capacity, they have the right to refuse resuscitation and have this recorded on a valid DNAR form.
• Best Interests Decision: If a resident lacks capacity, DNAR decisions should be made in their best interests, involving family members, legal representatives, or an Independent Mental Capacity Advocate (IMCA) where required.
• Advance Decisions to Refuse Treatment (ADRT): If a resident has a legally valid Advance Decision to Refuse Treatment (ADRT) declining resuscitation, this must be honoured and documented.
• Multidisciplinary Review: DNAR decisions must be reviewed regularly or when the resident’s condition changes.
• Emergency Situations: If no DNAR order is in place, CPR must be attempted unless it is clinically inappropriate (e.g., signs of irreversible death).

6. Documentation and Record-Keeping

To ensure compliance and clarity, all DNAR decisions must be:

• Documented on an official DNAR form signed by a GP or senior clinician.
• Recorded in the resident’s care plan and clearly communicated to all relevant staff.
• Reviewed periodically or when the resident’s condition changes.
• Stored securely but easily accessible in emergencies.

7. Staff Responsibilities and Training

All staff must understand their responsibilities regarding DNAR decisions:

• Care Staff:
  • Must be aware of DNAR decisions documented in care plans.
  • Should provide comfort and support to residents and families.
  • Must NOT attempt CPR if a valid DNAR order is in place.
• Nursing Staff:
  • Must ensure DNAR orders are correctly recorded and communicated.
  • Must liaise with GPs to review DNAR decisions when necessary.
• Management Team:
  • Ensures compliance with legal and regulatory requirements.
  • Provides emotional and professional support to staff dealing with DNAR situations.
• Training Requirements:
  • All staff must receive annual DNAR and end-of-life care training.
  • Training covers ethical considerations, legal requirements, and emergency response protocols.

8. Communication and Family Involvement

• Early Discussions: DNAR conversations should be introduced as part of routine advance care planning.
• Family Engagement: Where appropriate, families should be involved in discussions regarding DNAR decisions.
• Clear Explanation: DNAR does NOT mean withholding other medical treatments; residents will continue to receive appropriate care and symptom management.
• Conflict Resolution: If family members disagree with a DNAR decision, discussions should be escalated to a senior clinician or ethics committee if required.

9. Emergency Situations and Implementation of DNAR Orders

• If a DNAR is in place:
  • Staff must follow the directive and provide palliative care instead of resuscitation.
  • Ensure dignity and comfort measures are in place.
  • Document the event in the resident’s care notes and notify medical professionals.
• If a DNAR is NOT in place:
  • Staff must commence CPR unless there are obvious signs of irreversible death.
  • Emergency services must be contacted immediately.

10. Legal and Ethical Considerations

This policy ensures adherence to:

• Mental Capacity Act 2005: Ensuring decisions are made in the best interests of those lacking capacity.
• Human Rights Act 1998: Respecting the rights and dignity of residents.
• Resuscitation Council UK Guidelines: Following nationally recognised standards of care.
• General Medical Council (GMC) Guidance on End-of-Life Care: Ensuring ethical medical decision-making.

11. Auditing and Compliance Monitoring

To ensure ongoing compliance and best practice:

• Regular Policy Audits: DNAR documentation and adherence are reviewed at least annually.
• Case Reviews: Any incidents where DNAR orders were implemented are reviewed to ensure compliance.
• CIW Inspections: All DNAR documentation is available for regulatory inspection.
• Staff Feedback and Training Needs Analysis: Ensuring continuous improvement and competency development.

12. Policy Review

This policy will be reviewed annually or sooner if legal, regulatory, or operational changes occur. Any updates will be communicated to all employees to ensure continued compliance and best practice in DNAR decision-making.

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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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