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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 ensure that {{org_field_name}} follows a clear, ethical, and legally compliant approach to resuscitation and Do Not Attempt Resuscitation (DNAR) decisions. The policy ensures that service users’ rights, dignity, and choices regarding resuscitation are respected while also ensuring that our staff act appropriately and lawfully in situations where resuscitation may be required.

This policy is designed to:

• Ensure compliance with Care Inspectorate Wales (CIW) regulations, the Regulation and Inspection of Social Care (Wales) Act 2016, and relevant Welsh Government and NHS Wales guidelines.
• Provide clear guidance to staff on their role in responding to cardiac or respiratory arrest.
• Ensure that service users’ advance decisions and preferences are respected.
• Support staff in dealing with DNAR orders, including legal considerations and ethical responsibilities.
• Clarify record-keeping and communication procedures to ensure the correct decisions are followed in emergencies.

2. Scope

This policy applies to:

• All staff employed by {{org_field_name}}, including care workers, support workers, and managers.
• All individuals receiving domiciliary care services, particularly those with serious health conditions, end-of-life care needs, or DNAR decisions in place.
• Healthcare professionals and external agencies that work in partnership with {{org_field_name}} in delivering care.

3. Policy Statement

{{org_field_name}} respects the right of service users to make informed decisions about their medical treatment, including whether or not they wish to receive resuscitation. We are committed to ensuring that:

• Resuscitation is only attempted where appropriate and in line with legal and ethical guidelines.
• DNAR orders are recognised, recorded, and followed correctly.
• Staff are trained and competent in dealing with medical emergencies and understanding DNAR decisions.
• Family members and relevant professionals are informed where necessary, ensuring a coordinated approach to care.

We recognise that staff in domiciliary care do not have a legal duty to perform CPR, but they must act in accordance with DNAR orders and escalate emergencies appropriately.

4. Managing Resuscitation and DNAR Efficiently

4.1. Understanding DNAR Orders

A Do Not Attempt Resuscitation (DNAR) order is a medical decision made by a doctor or healthcare professional stating that cardiopulmonary resuscitation (CPR) should not be attempted in the event of cardiac or respiratory arrest. DNAR decisions are made based on:

• The service user’s wishes and informed consent.
• Medical judgment that CPR would not be beneficial.
• Discussions with the individual’s family, where appropriate.
• The Mental Capacity Act 2005, ensuring best interests are considered for individuals lacking capacity.

A DNAR order does not mean other medical treatments should be withheld. Service users with DNAR orders should continue to receive full personal care, pain relief, hydration, and dignity in care.

4.2. Staff Responsibilities in the Event of a Medical Emergency

If a service user collapses or is unresponsive, staff must:

• Check for a DNAR decision on record.
• If a DNAR order exists, staff must not perform CPR but should still provide comfort, reassurance, and appropriate support (e.g., placing the individual in a comfortable position and monitoring breathing).
• If no DNAR order is in place, staff must call 999 immediately and follow the instructions provided by emergency services.
• If uncertain about a DNAR order, call 999 and explain the situation clearly.
• Always document the incident accurately in care records.

4.3. Communicating DNAR Decisions

To ensure that DNAR orders are properly followed:

• DNAR decisions must be clearly recorded in the service user’s care plan.
• Staff must be informed of DNAR orders as part of handovers and documentation.
• DNAR forms must be easily accessible in service users’ homes but stored confidentially.
• Families and relevant healthcare professionals must be kept informed of DNAR decisions when appropriate.

Staff must never influence or challenge a service user’s DNAR decision but should ensure that individuals understand their options.

4.4. Staff Training and Competency

All care staff must receive training on:

• Understanding DNAR orders and legal implications.
• Recognising and responding to cardiac and respiratory emergencies.
• Communicating with service users about DNAR sensitively and professionally.
• Record-keeping and information-sharing procedures.

Training will be mandatory upon induction and refreshed annually to ensure staff are confident in their role.

4.5. Record-Keeping and Documentation

Accurate record-keeping is crucial to ensuring that DNAR decisions are respected. Staff must:

• Record DNAR orders clearly in the service user’s care plan.
• Ensure that the DNAR form is up to date and signed by the relevant healthcare professional.
• Document any discussions regarding DNAR and resuscitation decisions.
• Report any uncertainty or changes in a service user’s condition to the manager or medical professional immediately.

4.6. Legal and Ethical Considerations

Staff must always act within the law and follow ethical guidelines. This means:

• Respecting the rights and dignity of service users.
• Ensuring DNAR decisions are made in accordance with the Mental Capacity Act 2005, with best interests in mind for individuals who lack capacity.
• Recognising that care staff are not legally required to perform CPR, but must ensure emergency services are contacted promptly.
• Following all Welsh Government and NHS Wales guidance on end-of-life care.

4.7. Reviewing DNAR Decisions

DNAR orders should be reviewed regularly to ensure they remain valid. This includes:

• Periodic reviews by the service user’s GP or medical team.
• Updating care records if a DNAR order is revoked or amended.
• Discussing DNAR orders during care plan reviews and multidisciplinary meetings.
• Ensuring staff are aware of any changes to DNAR orders through communication and documentation updates.

5. Related Policies

This policy aligns with and should be read alongside the following:

• End of Life and Palliative Care Policy (DCW38) – Covers broader end-of-life care approaches.
• Mental Capacity and Deprivation of Liberty Safeguards Policy (DCW39) – Ensures that DNAR decisions comply with capacity law.
• Safe Care and Treatment Policy (DCW11) – Covers emergency response and care planning.
• Confidentiality and Data Protection Policy (DCW34) – Ensures DNAR records are handled securely.

6. Policy Review

This policy will be reviewed annually or sooner if required due to legislative changes, regulatory updates, or case-specific incidents requiring amendments. All updates will be communicated to staff and included in refresher training.

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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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