{{org_field_logo}}

{{org_field_name}}

Registration Number: {{org_field_registration_no}}

---

Resuscitation and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) 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 (DNACPR) 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 uses the term Do Not Attempt Cardiopulmonary Resuscitation (DNACPR). DNACPR relates only to the decision not to attempt cardiopulmonary resuscitation if the individual has a cardiac or respiratory arrest. It does not mean that any other treatment, care, support, comfort measures, pain relief, hydration, nutrition, medication, emotional support, palliative care, personal care, or emergency treatment for other conditions should be withheld or delayed.

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 DNACPR orders, including legal considerations and ethical responsibilities.
• Clarify record-keeping and communication procedures to ensure the correct decisions are followed in emergencies.

• Ensure that staff understand the current All Wales DNACPR Policy for Adults (18+) in Wales and the need for DNACPR decisions to be recorded, communicated, reviewed and acted upon safely across health and social care settings.
• Ensure that DNACPR information is reflected accurately in the individual’s provider assessment, personal plan, risk assessment, end of life care plan and daily care records, where applicable.
• Ensure that staff understand when to call 999, when to follow a valid DNACPR decision, and when to seek urgent clinical advice because the position is unclear.

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 DNACPR decisions in place.
• Healthcare professionals and external agencies that work in partnership with {{org_field_name}} in delivering care.

This policy applies to adults receiving domiciliary support services from {{org_field_name}}. Where {{org_field_name}} provides care and support to a child or young person under the age of 18, any decision relating to attempted CPR must be managed through the child’s relevant medical practitioner, specialist health team, parent or person with parental responsibility, and any applicable legal framework. Staff must not assume that the adult All Wales DNACPR process applies to a child or young person.

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.
• DNACPR orders are recognised, recorded, and followed correctly.
• Staff are trained and competent in dealing with medical emergencies and understanding DNACPR decisions.
• Family members and relevant professionals are informed where necessary, ensuring a coordinated approach to care.

DNACPR decisions must never be made, requested, applied or assumed on the basis of age, disability, diagnosis, frailty, learning disability, autism, dementia, mental health need, race, religion or belief, sex, sexual orientation, gender reassignment, marital or civil partnership status, pregnancy or maternity, social circumstances, or because an individual receives care and support. Each decision must be individual, clinically led, person-centred, lawful and properly communicated.

Staff must respond promptly and safely to any medical emergency in line with this policy, their training, the individual’s personal plan, any valid and applicable DNACPR decision, and the instructions of emergency services. Where there is no valid and immediately available DNACPR decision, or where staff are unsure whether a DNACPR decision applies, staff must call 999 immediately and follow the instructions given by the emergency call handler.

4. Managing Resuscitation and DNACPR Decisions Safely

4.1. Understanding DNACPR Decisions

A Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision is a clinical decision or recommendation that CPR should not be attempted if the individual has a cardiac or respiratory arrest. In Wales, adult DNACPR decisions should be made and recorded in line with the current All Wales DNACPR Policy for Adults (18+) in Wales and the recognised All Wales DNACPR documentation. DNACPR relates only to CPR. It does not apply to other care or treatment, including personal care, medication, oxygen, antibiotics, fluids, nutrition, pain relief, comfort care, palliative care, hospital admission, or treatment for reversible conditions unless these are addressed separately in an advance care plan, treatment escalation plan, ReSPECT plan, clinical plan, or legally valid advance decision.

DNACPR decisions may arise where:

• the individual has capacity and refuses CPR or requests that CPR is not attempted;
• CPR would not restart the person’s heart and breathing;
• the burdens, risks or likely harms of CPR would outweigh any realistic benefit;
• there is a valid and applicable Advance Decision to Refuse Treatment (ADRT) refusing CPR;
• the decision has been made by an appropriate senior clinician following assessment, consultation and best interests decision-making where the individual lacks capacity.

A DNACPR decision does not mean that any other treatment or care should be withheld. Staff must continue to provide all agreed care and support in line with the individual’s personal plan, including dignity, comfort, personal care, emotional support, pain relief, hydration and nutrition support where part of the agreed care plan, and timely escalation of other health concerns.

4.2. The All Wales DNACPR Form

For adults in Wales, staff must expect DNACPR decisions to be recorded on the current All Wales DNACPR Form or within current NHS Wales recognised documentation. The form is completed by an appropriate healthcare professional and is for use by health professionals; care staff must not create, alter, sign, cancel or make a DNACPR decision.

Staff must check that any DNACPR information available to them:

• clearly identifies the individual;
• is legible;
• appears complete;
• has been signed and dated by the appropriate healthcare professional;
• is the most recent version available in the home or care record;
• has not been cancelled, crossed through, superseded or contradicted by more recent clinical information;
• is reflected in the individual’s personal plan and emergency information.

Where staff cannot locate the DNACPR form, cannot read it, believe it may relate to another person, believe it has been cancelled, or are unsure whether it applies to the current situation, they must call 999 immediately and follow the instructions of the emergency call handler.

4.3. Advance Decisions, Advance Statements, Lasting Power of Attorney and Emergency Care Plans

Staff must understand the difference between the following:

• DNACPR: a clinical decision or recommendation that CPR should not be attempted. It applies only to CPR.
• Advance Decision to Refuse Treatment (ADRT): a legally binding refusal of specified medical treatment made by a person aged 18 or over who had capacity at the time of making it. If it refuses life-sustaining treatment, it must meet the legal requirements of the Mental Capacity Act 2005, including being in writing, signed, witnessed, and stating that it applies even if life is at risk.
• Advance statement: a statement of the individual’s wishes, feelings, beliefs and preferences. It is not legally binding in the same way as an ADRT, but it must be considered when planning care and making best interests decisions.
• Lasting Power of Attorney for Health and Welfare: a person legally appointed to make health and welfare decisions if the individual lacks capacity, but only within the authority granted by the LPA. Staff must ask the manager to verify the document before relying on it.
• ReSPECT, treatment escalation plan, advance care plan or future care plan: a personalised record of clinical recommendations and the individual’s wishes for emergency care and treatment. Staff must follow the parts relevant to their role and must seek urgent clinical advice where unclear.

Any information about DNACPR, ADRT, advance statements, LPA, ReSPECT or other emergency care plans must be recorded in the individual’s personal plan, communicated to relevant staff, and reviewed when care needs change.

4.4. Staff Responsibilities in the Event of a Medical Emergency

If an individual collapses, is unresponsive, appears not to be breathing normally, or staff believe the individual may be in cardiac or respiratory arrest, staff must:

• check for immediate danger and ensure their own safety;
• try to gain a response from the individual;
• call for help if another person is present;
• check whether there is a clearly documented and immediately available DNACPR decision in the individual’s home, emergency folder, personal plan or electronic care record;
• call 999 immediately if there is no valid and applicable DNACPR decision immediately available;
• call 999 immediately if staff are uncertain, the form is not available, the form is unclear, the form appears incomplete, the form may have been cancelled, the individual’s identity is unclear, or the circumstances do not match the plan;
• follow the instructions of the emergency call handler;
• if a valid and applicable DNACPR decision is available, do not commence CPR, but continue to provide comfort, dignity, reassurance, privacy and support in line with the individual’s personal plan and any end of life care plan;
• contact the office, on-call manager or responsible manager as soon as it is safe to do so;
• preserve the DNACPR form and any related records for review by healthcare professionals;
• record the incident fully, including times, observations, actions taken, people contacted, instructions received and the outcome.

Staff must not make a clinical decision that CPR is inappropriate. Staff must either follow a valid and applicable DNACPR decision or seek emergency clinical advice by calling 999.

4.5. Expected Death, Natural Anticipated Death and End of Life Care

Where an individual is receiving end of life care and death is expected, the personal plan must clearly record:

• the individual’s wishes and preferences;
• any DNACPR decision;
• any advance care plan, ReSPECT plan, treatment escalation plan, anticipatory care plan or palliative care plan;
• who should be contacted when the individual appears to be dying or has died;
• whether the GP, district nurse, palliative care team, out of hours service or 999 should be contacted;
• what comfort care staff may provide within their role;
• any cultural, spiritual, religious or family wishes;
• where relevant, arrangements for verification of death by an appropriate healthcare professional.

Staff must not assume that a death is expected unless this is clearly documented in the personal plan and supported by current healthcare professional guidance. If staff are unsure whether death is expected, or if there are any unusual, sudden, unexplained, traumatic or suspicious circumstances, staff must call 999 and inform the manager immediately.

4.6. Communicating DNACPR Decisions

To ensure that DNACPR decisions are communicated and followed safely:

• the manager or nominated senior staff member must ensure that any DNACPR information is reflected in the individual’s provider assessment, personal plan, risk assessment and emergency information;
• care staff must be informed of the existence and location of the DNACPR form before providing care, where this is relevant to their role;
• the DNACPR form must be kept in an agreed, accessible location in the individual’s home, usually with other emergency care information, while still respecting confidentiality;
• the care record must state where the original form is kept;
• electronic care systems must clearly alert staff that a DNACPR decision exists, without exposing unnecessary confidential information;
• the individual must be involved in communication about the decision wherever they have capacity and wish to be involved;
• representatives, family members or others close to the individual must only be informed where the individual consents, where they have lawful authority, or where sharing is otherwise lawful and necessary;
• where the individual lacks capacity, communication must follow the Mental Capacity Act 2005, best interests requirements, confidentiality requirements and any valid legal authority;
• relevant healthcare professionals, commissioners and other care providers must be informed where necessary for safe continuity of care and lawful information-sharing;
• staff must report immediately if a DNACPR form is missing, damaged, illegible, inconsistent with the personal plan, or appears to have been changed.

Staff must not pressure, persuade, coerce or direct an individual about DNACPR decisions. Staff may listen, provide reassurance, explain the limits of their role, and support the individual to speak with their GP, district nurse, palliative care team or other relevant healthcare professional. If an individual appears distressed, confused, uncertain, or says that the recorded decision no longer reflects their wishes, staff must report this immediately to the manager so that urgent clinical review can be requested.

4.7. Staff Training and Competency

All relevant staff must receive training appropriate to their role. Training must include:

• recognising medical emergencies, cardiac arrest and respiratory arrest;
• when and how to call 999;
• basic life support awareness appropriate to the staff role and service training matrix;
• the meaning and limits of DNACPR;
• the current All Wales DNACPR arrangements for adults in Wales;
• how to locate and check DNACPR information in the home and care record;
• what to do if a DNACPR form is missing, unclear, unavailable, incomplete, cancelled or disputed;
• the difference between DNACPR, ADRT, advance statements, LPA, ReSPECT, treatment escalation plans and advance care plans;
• Mental Capacity Act 2005 principles and best interests decision-making;
• confidentiality, lawful information-sharing and accurate record keeping;
• dignity, comfort care and communication at the end of life;
• duty of candour, safeguarding and escalation of concerns.

Training must be completed during induction before staff work unsupervised with individuals who have DNACPR or end of life care arrangements. Refresher training must be completed at least annually, or sooner where legislation, guidance, local procedures, audit findings, incidents or staff competency concerns identify a need.

4.8. Record-Keeping and Documentation

Staff and managers must ensure that DNACPR and emergency care information is recorded accurately, securely and consistently. Records must include:

• whether a DNACPR decision is in place;
• the date of the DNACPR decision;
• the name and role of the healthcare professional who completed or reviewed it, where known;
• where the original DNACPR form is kept in the individual’s home;
• whether the decision is reflected in the personal plan, risk assessment and emergency information;
• any ADRT, advance statement, LPA for health and welfare, ReSPECT plan, advance care plan, treatment escalation plan or palliative care plan;
• discussions with the individual, representative, family, commissioner or healthcare professionals, where lawful and relevant;
• any concerns that the form is missing, unclear, cancelled, damaged, inconsistent, out of date, or no longer reflects the individual’s wishes;
• actions taken to obtain clarification or review;
• emergency incidents, including times, observations, calls made, instructions received, actions taken and outcome.

Records must be factual, dated, signed or electronically attributable, and completed as soon as possible after the event. DNACPR records must be stored securely and shared only where lawful and necessary for safe care.

The manager must audit DNACPR records at least quarterly where the service supports individuals with DNACPR decisions. The audit must check that records are current, forms are accessible, staff know where forms are kept, care plans are consistent, and any required reviews or escalations have been completed.

4.9. Notifications, Incidents and Escalation

The manager must review any resuscitation, DNACPR, sudden death, unexpected death, serious injury, safeguarding concern or emergency incident to decide whether notification is required to CIW, the commissioner, the local authority safeguarding team, the police, the health board, or any other relevant body.

CIW notifications must be made without delay and in the form and manner required by CIW where the event is notifiable under the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended. This may include, but is not limited to:

• any abuse or allegation of abuse involving the provider, staff or volunteers;
• any allegation of misconduct by a member of staff;
• serious accident or injury to an individual;
• any incident reported to the police;
• any event that prevents, or could prevent, the service from being provided safely.

The responsible individual and manager must ensure that incidents are reviewed, lessons are learned, and any required changes are made to the individual’s personal plan, risk assessment, staff training, records or this policy.

4.10. 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 DNACPR decisions are made in accordance with the Mental Capacity Act 2005, with best interests in mind for individuals who lack capacity.
• Staff must act within their role, training, this policy, the individual’s personal plan, any valid and applicable DNACPR decision, and the instructions of emergency services. Where there is no valid and applicable DNACPR decision immediately available, staff must call 999 and follow the emergency call handler’s instructions.
• Following all Welsh Government and NHS Wales guidance on end-of-life care.

• DNACPR decisions must comply with the Human Rights Act 1998, Equality Act 2010, Mental Capacity Act 2005, common law confidentiality requirements, data protection legislation and relevant Welsh health and social care guidance.
• Where the individual has capacity, their informed wishes and decisions must be respected.
• Where the individual lacks capacity, decisions must be made in accordance with the Mental Capacity Act 2005 and must be in the individual’s best interests.
• A family member cannot make a DNACPR decision unless they have the relevant legal authority. Family members and those close to the individual should be involved where appropriate and lawful, but clinical responsibility for DNACPR rests with the appropriate healthcare professional.
• Staff must not discriminate, make assumptions, or apply blanket DNACPR decisions to groups of people.
• Staff must raise a safeguarding concern if they believe a DNACPR decision has been applied in a discriminatory, coercive, abusive or unsafe way.

4.11. Reviewing DNACPR Decisions and Care Plans

DNACPR decisions must be reviewed by an appropriate healthcare professional in line with the All Wales DNACPR Policy and whenever clinically required. {{org_field_name}} is not responsible for making the clinical DNACPR decision, but must support safe review by:

• checking during assessment, care planning and review whether DNACPR or emergency care planning information is in place;
• ensuring the personal plan reflects current DNACPR, ADRT, advance care planning, LPA and emergency care information;
• requesting clinical review through the GP, district nurse, palliative care team, out of hours service or other relevant professional where information is unclear, missing, inconsistent or appears out of date;
• reporting immediately if the individual states that their wishes have changed;
• updating care records promptly when a DNACPR decision is reviewed, cancelled, replaced or amended;
• ensuring staff are informed of any changes before they next provide care;
• checking DNACPR information at each scheduled care review and whenever there is a significant change in the individual’s health, mental capacity, care arrangements, place of care, or expressed wishes.

4.12. Provider Assessment and Personal Plan

Where an individual has serious illness, deteriorating health, palliative care needs, end of life care needs, an ADRT, DNACPR decision, advance statement, LPA for health and welfare, ReSPECT plan, treatment escalation plan or advance care plan, this must be considered as part of the provider assessment and personal planning process.

The personal plan must clearly record:

• the individual’s wishes and preferences;
• how care and support will be provided on a day-to-day basis;
• any DNACPR decision and where the form is kept;
• any ADRT, advance statement, LPA or emergency care plan;
• what staff must do in a medical emergency;
• who staff must contact during office hours and out of hours;
• any comfort care or palliative care actions staff may provide within their role;
• any communication, language, cultural, religious or spiritual needs;
• any risks and actions required to reduce those risks.

The personal plan must be reviewed at least every three months, or sooner if the individual’s needs, wishes, capacity, health condition, DNACPR status or emergency care arrangements change.

4.13. Duty of Candour

{{org_field_name}} will act in an open and transparent way with individuals and, where lawful and appropriate, their representatives, family members, commissioners and relevant professionals. Where something goes wrong in relation to resuscitation, DNACPR, emergency response, communication, records or end of life care, the manager and responsible individual must ensure that:

• the individual and/or relevant representative is informed as soon as reasonably practicable;
• an apology is offered where appropriate;
• the incident is investigated;
• the outcome and learning are shared where lawful and appropriate;
• safeguarding, CIW notification, commissioner notification and professional referral duties are considered;
• action is taken to reduce the risk of recurrence.

4.14. Safeguarding Concerns Relating to DNACPR

Staff must raise a safeguarding concern immediately in line with the Safeguarding Policy if they believe that:

• a DNACPR decision has been applied without proper individual consideration;
• the individual has been pressured, coerced or misled;
• a family member, representative, staff member or professional is attempting to impose a decision without lawful authority;
• a DNACPR decision appears discriminatory;
• the individual’s expressed wishes are being ignored;
• an ADRT, LPA, advance care plan or DNACPR form may have been falsified, altered, hidden or misused;
• failure to follow emergency procedures has placed the individual at risk of harm.

The manager must take immediate action to protect the individual, seek clinical advice, preserve relevant records, and make referrals to safeguarding agencies, CIW, commissioners, police or professional bodies where required.

4.15. Welsh Language and Accessible Communication

DNACPR, emergency care and end of life information must be discussed and shared in a way the individual can understand. Reasonable steps must be taken to meet the individual’s language and communication needs, including Welsh language needs, accessible formats, advocacy, interpretation, communication aids, and support from people who know the individual well where lawful and appropriate.

Staff must record the individual’s preferred language and communication needs in the personal plan and must seek support from the manager if they are unable to communicate effectively with the individual about emergency care or end of life matters.

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 DNACPR decisions comply with capacity law.
• Safe Care and Treatment Policy (DCW11) – Covers emergency response and care planning.
• Confidentiality and Data Protection Policy (DCW34) – Ensures DNACPR records are handled securely.

• Mental Capacity Act 2005 and Best Interests Policy – Sets out how capacity, best interests, ADRT and LPA issues are managed.
• Safeguarding Adults and Children Policy – Covers concerns about coercion, discrimination, neglect, improper treatment or unsafe DNACPR practice.
• Duty of Candour Policy – Covers openness, apology, investigation and learning where something goes wrong.
• Incident Reporting and CIW Notifications Policy – Covers notifiable events, serious incidents, deaths, emergency incidents and reporting requirements.
• Care Planning and Risk Assessment Policy – Covers provider assessment, personal plans, reviews and emergency information.
• End of Life, Palliative Care and Advance Care Planning Policy – Covers advance statements, ADRT, ReSPECT, treatment escalation plans and individual wishes.
• Welsh Language and Accessible Information Policy – Covers communication, interpretation, accessible formats and Welsh language needs.
• Staff Training and Competency Policy – Covers induction, refresher training, supervision and competency checks.

6. Policy Review

This policy will be reviewed at least annually, or sooner where there are changes to legislation, Welsh Government guidance, CIW requirements, NHS Wales DNACPR guidance, Resuscitation Council UK guidance, safeguarding procedures, professional guidance, local health board arrangements, audit findings, incidents, complaints, safeguarding concerns, or learning from practice. The manager and responsible individual will ensure that any changes are communicated to staff, reflected in training, and implemented in care planning and practice.

---

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.