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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 provide a clear, consistent, and legally compliant framework for the management of resuscitation and Do Not Attempt Resuscitation (DNAR) decisions within {{org_field_name}}. Our aim is to ensure that service users’ rights, dignity, and best interests are upheld while maintaining compliance with healthcare laws, ethical guidelines, and professional responsibilities. This policy ensures that all staff understand their roles in managing DNAR decisions and resuscitation efforts effectively and sensitively.

2. Scope

This policy applies to all employees, care workers, agency staff, and management involved in the provision of domiciliary care services. It covers:

• The legal and ethical principles surrounding resuscitation.
• How DNAR decisions are made, recorded, and respected.
• The role of care workers in emergency situations.
• Training and competency requirements.
• Communication with service users, families, and healthcare professionals.
• Compliance with legal and regulatory standards.

3. Legal and Regulatory Framework

This policy aligns with the following legislation and regulatory guidance:

• Mental Capacity Act 2005 – Ensures service users have the right to make their own decisions or have decisions made in their best interests.
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Outlines care providers’ obligations in delivering safe and respectful care.
• Resuscitation Council UK Guidelines – Provides best practice recommendations on DNAR decisions and emergency response.
• Care Quality Commission (CQC) Fundamental Standards – Ensures high standards of person-centred care, including DNAR compliance.
• General Data Protection Regulation (GDPR) 2018 – Governs confidentiality and secure storage of DNAR orders and medical records.
• Human Rights Act 1998 – Protects the rights and dignity of service users in medical decision-making.

4. Understanding Resuscitation and DNAR Decisions

• Resuscitation (CPR): Cardiopulmonary resuscitation (CPR) is a medical procedure used in emergencies when someone’s heart or breathing stops.
• DNAR Decision: A DNAR (Do Not Attempt Resuscitation) order is a medical directive stating that CPR should not be attempted if the service user experiences cardiac or respiratory arrest.
• Advance Decisions (Living Wills): Some service users may have an Advance Decision to Refuse Treatment (ADRT), including refusal of CPR, which must be respected.

5. Making and Recording DNAR Decisions

• DNAR decisions must be made by a qualified healthcare professional (e.g., a GP or consultant) in consultation with the service user and/or their legal representatives.
• DNAR orders must be clearly documented in the service user’s medical records and communicated to relevant care staff.
• A DNAR form should be kept in the service user’s home in an easily accessible place, such as a care folder, to ensure emergency responders are aware of the directive.
• DNAR decisions must be reviewed regularly by the healthcare team and updated as necessary.

6. Role of Care Workers in DNAR and Emergency Situations

• When a service user has a DNAR order:
  • Care workers must not initiate CPR if the service user experiences cardiac or respiratory arrest.
  • Emergency services (999) must still be called if appropriate, ensuring paramedics are aware of the DNAR order.
  • Care workers must provide comfort, reassurance, and dignity to the service user and their family.
  • The DNAR decision must be communicated to attending emergency personnel to prevent unnecessary resuscitation efforts.
• When a service user does not have a DNAR order:
  • Care workers must call 999 or 112 immediately.
  • If trained and it is safe to do so, care workers may begin CPR until emergency personnel arrive.
  • All actions taken must be documented accurately.

7. Communication and Respect for Service User Wishes

• Service users have the right to discuss their preferences regarding resuscitation and end-of-life care.
• Care workers must approach DNAR discussions sensitively, ensuring service users and their families have the necessary support.
• Any concerns about a DNAR decision must be referred to the service user’s GP or medical team for clarification.
• If a DNAR order is unclear or missing, emergency medical assistance must be sought, and CPR should be initiated if appropriate.

8. Training and Staff Responsibilities

• Mandatory Training: All care workers must undergo training on:
  • Understanding DNAR decisions and legal responsibilities.
  • Recognising and responding to medical emergencies.
  • Providing end-of-life care and emotional support.
  • Communicating sensitively with service users and families.
• Refresher Training: DNAR policy and emergency response training must be refreshed annually to ensure competency.
• Accountability: Care workers must report any concerns about DNAR compliance or miscommunication to their line manager.

9. Compliance Monitoring and Policy Enforcement

To ensure compliance with this policy, {{org_field_name}}:

• Conducts regular audits of DNAR documentation and adherence to procedures.
• Reviews incident reports where DNAR-related issues arise.
• Seeks feedback from service users and families on DNAR handling.
• Provides ongoing guidance to staff on DNAR regulations and best practices.
• Maintains clear communication with healthcare providers to ensure up-to-date DNAR orders are respected.

10. Policy Review and Updates

This policy is reviewed annually or sooner if significant updates occur in legal or medical guidelines. Any amendments are communicated to staff, and further training is provided as necessary.

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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}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.