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Resuscitation or DNAR Policy

Purpose

The purpose of this policy is to provide clear guidance on resuscitation decisions, including Do Not Attempt Resuscitation (DNAR) orders, within {{org_field_name}}. The policy ensures that all staff understand their responsibilities in supporting individuals’ rights, choices, and medical needs while complying with Scottish legal and ethical frameworks.

This policy promotes:

• The dignity and wishes of the people we support.
• Compliance with legal and ethical standards.
• Clear procedures for decision-making and documentation.
• Safe and appropriate responses in the event of a cardiopulmonary arrest.

Scope

This policy applies to all staff members within {{org_field_name}}, including care workers, registered nurses, management, and administrative personnel involved in supporting and respecting decisions related to resuscitation and DNAR orders.

It covers:

• The principles of resuscitation.
• The legal and ethical framework in Scotland.
• Procedures for implementing and documenting DNAR decisions.
• The responsibilities of staff in emergency situations.
• Communication with individuals, families, and healthcare professionals.

Related Policies

This policy should be read in conjunction with:

• End-of-Life Care Policy – Ensuring compassionate care for individuals approaching end of life.
• Consent and Capacity Policy – Addressing decision-making when capacity is impaired.
• Risk Assessment and Management Policy – Supporting informed choices about healthcare interventions.
• Safeguarding Policy – Protecting vulnerable individuals when making healthcare decisions.
• Communication and Confidentiality Policy – Maintaining privacy and dignity in resuscitation discussions.

Legal and Regulatory Framework

This policy aligns with relevant Scottish laws, regulations, and professional guidelines, including:

• Adults with Incapacity (Scotland) Act 2000 – Governing decision-making for individuals lacking capacity.
• Health and Social Care Standards Scotland – Ensuring person-centred and rights-based care.
• Scottish Intercollegiate Guidelines Network (SIGN) Guidance on DNACPR – Best practice recommendations.
• The Mental Health (Care and Treatment) (Scotland) Act 2003 – Addressing capacity and decision-making in mental health.
• Scottish Government DNACPR Policy – Providing national guidance on resuscitation decisions.
• General Medical Council (GMC) Guidance on Treatment and Care Towards the End of Life – Ethical standards for DNAR decisions.

Principles of Resuscitation

Resuscitation refers to the emergency medical procedures performed to restore heartbeat and breathing following cardiac or respiratory arrest. In a home care setting, resuscitation primarily involves:

Basic Life Support (BLS)

Basic Life Support is a fundamental emergency response technique that involves:

1. Assessing Responsiveness – Check if the person is unresponsive by gently shaking and calling their name.
2. Checking for Breathing – Look, listen, and feel for normal breathing for up to 10 seconds.
3. Calling for Help – If unresponsive and not breathing, call 999 immediately and request emergency assistance.
4. Performing Chest Compressions –
   • Position the individual on a firm, flat surface.
   • Place the heel of one hand in the centre of the chest (on the sternum), with the other hand on top.
   • Push hard and fast at a rate of 100-120 compressions per minute, with a depth of 5-6 cm.
5. Rescue Breaths (If Trained to Provide Mouth-to-Mouth) –
   • Tilt the head back to open the airway.
   • Pinch the nose and give two breaths, ensuring the chest rises.
   • Continue cycles of 30 compressions and 2 breaths until professional help arrives.

Use of an Automated External Defibrillator (AED)

An AED is a portable device used to deliver an electric shock to restart the heart. Steps include:

1. Turn on the AED and follow the instructions.
2. Attach the adhesive electrode pads to the individual’s bare chest as indicated.
3. Allow the AED to analyze the heart rhythm.
4. If advised, press the shock button and ensure no one is touching the individual.
5. Continue CPR until emergency responders take over.

Emergency Services Contact

• Promptly call 999 for medical assistance in all resuscitation attempts.
• Provide clear information on the individual’s condition and any medical history.
• If resuscitation has been attempted, inform emergency responders about the interventions provided.

However, not all individuals will wish to receive resuscitation. DNAR decisions must be made in advance, respecting the individual’s choices and medical needs. Resuscitation refers to the emergency medical procedures performed to restore heartbeat and breathing following cardiac or respiratory arrest. In a home care setting, resuscitation primarily involves:

• Basic Life Support (BLS) – Chest compressions and rescue breaths.
• Use of an Automated External Defibrillator (AED) – If available and appropriate.
• Emergency Services Contact – Promptly calling 999 for medical assistance.

However, not all individuals will wish to receive resuscitation. DNAR decisions must be made in advance, respecting the individual’s choices and medical needs.

Do Not Attempt Resuscitation (DNAR) Decisions

Definition

A Do Not Attempt Resuscitation (DNAR) decision is a medical order stating that resuscitation should not be attempted in the event of cardiac or respiratory arrest. DNAR decisions do not mean withholding all medical treatment; individuals should still receive appropriate care, comfort, and symptom management.

Criteria for DNAR Decisions

A DNAR decision may be made when:

• The individual has expressed a clear wish not to be resuscitated.
• Resuscitation would be futile or ineffective due to advanced illness.
• A healthcare professional deems resuscitation clinically inappropriate based on medical judgment.
• An individual lacks capacity, and a DNAR decision is made in their best interests following legal procedures.

Capacity and Consent

• Individuals with capacity have the right to refuse resuscitation and should be supported in making an informed decision.
• If an individual lacks capacity, decisions must be made following the Adults with Incapacity (Scotland) Act 2000, ensuring that:
  • Their previously expressed wishes are considered.
  • Family members and legal representatives are consulted.
  • The decision aligns with their best interests.

Legal Validity of DNAR Forms

A DNAR order must be documented on an official Scottish DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) Form. This form should:

• Be signed by a qualified healthcare professional (e.g., GP or consultant).
• Be accessible in the individual’s care records.
• Be regularly reviewed, especially if the individual’s condition changes.

Responsibilities of Staff

• Ensure all DNAR decisions are recorded in the individual’s personal care plan.
• Be aware of the location of DNAR documentation.
• Respect and follow DNAR decisions in an emergency.
• Communicate sensitively with individuals and their families regarding DNAR decisions.
• Refer any concerns about DNAR documentation to healthcare professionals.

Emergency Response in DNAR Cases

In the event of a medical emergency:

1. Check for a DNAR Form – If a valid DNAR order is in place, do not attempt resuscitation.
2. Provide Comfort Care – Ensure the individual is comfortable and reassure family members.
3. Call Emergency Services (999 or 112) – Inform them of the individual’s DNAR status.
4. Document the Incident – Record details of the event, including any communication with emergency personnel and family members.

If a DNAR order is not present or unclear, staff must initiate resuscitation until professional help arrives.

Communication and Family Involvement

Discussing DNAR Decisions

• Conversations about DNAR decisions should be handled with sensitivity, ensuring the individual’s views are heard.
• Where appropriate, discussions should involve family members or legal representatives.
• Information should be provided in clear, accessible language, ensuring understanding of what a DNAR decision means.

Handling Disagreements

In cases where family members disagree with a DNAR decision:

• Staff should explain the legal and medical basis of the decision.
• Refer concerns to the responsible healthcare professional.
• Ensure respectful, empathetic communication to support families during difficult times.

Staff Training and Responsibilities

All staff members must receive training on:

• CPR and Basic Life Support (BLS) – Understanding when and how to administer resuscitation.
• DNAR Orders and Legal Frameworks – Recognising valid DNAR documentation and responding appropriately.
• Ethical and Communication Skills – Handling sensitive conversations with individuals and families.
• Record-Keeping Requirements – Ensuring accurate documentation of DNAR decisions.

Staff must:

• Follow all DNAR decisions as documented.
• Seek guidance if uncertain about a DNAR order.
• Report any ethical concerns to management or healthcare professionals.

Documentation and Record-Keeping

Accurate record-keeping is essential for compliance and quality of care. Documentation should include:

• DNAR forms and updates to individual care plans.
• Records of discussions with individuals and families about DNAR decisions.
• Incident reports if resuscitation is attempted or withheld.
• Training records confirming staff competency in DNAR procedures.

Policy Review

This policy will be reviewed annually or sooner if there are changes in legislation, guidance, or best practices. Updates will ensure continued compliance with Scottish law and ethical standards in DNAR decision-making.

For further information, contact {{org_field_name}} at {{org_field_email}}.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
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