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HCS71-Resuscitation and DNACPR Policy

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Resuscitation and DNACPR Policy

1. Purpose

The purpose of this policy is to provide clear guidance on resuscitation decisions, including Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions, 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.

For the purposes of this policy, the term DNACPR means a decision that cardiopulmonary resuscitation should not be attempted if the person has a cardiac or respiratory arrest. A DNACPR decision applies only to CPR. It does not mean that other care, treatment, comfort measures, symptom relief, emergency treatment, palliative care, personal care or support will be withheld.

This policy promotes:

2. Scope

This policy applies to all staff members within {{org_field_name}}, including care workers, managers, coordinators, registered nurses where employed, and administrative staff who may be involved in recording, locating, communicating or responding to information about resuscitation and DNACPR decisions. In a care at home setting, staff must understand that DNACPR decision-making is a clinical responsibility. The role of care at home staff is to follow this policy, respond safely in an emergency, check and communicate relevant documentation, record accurately, and escalate concerns to the appropriate healthcare professional or manager.

It covers:

3. Related Policies

This policy should be read in conjunction with:

4. Legal and Regulatory Framework

This policy is written for Care at Home services in Scotland and must be read alongside current legislation, regulatory requirements, professional codes and clinical guidance. The service will comply with the following:

5. 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.

Where a person is unresponsive and not breathing normally, staff must call 999 immediately and follow emergency call handler instructions unless there is a valid and immediately available DNACPR form or clear clinical instruction from an appropriate healthcare professional. If there is no valid DNACPR form available, or if staff are unsure whether the form applies, staff must start CPR if they are trained and able to do so, follow the instructions of the emergency call handler, and continue until emergency services arrive or they are instructed to stop by an appropriate healthcare professional.

Staff must understand that a DNACPR decision applies only to CPR. It does not prevent staff from seeking urgent help, providing comfort, maintaining dignity, supporting breathing where appropriate, treating choking, responding to anaphylaxis, managing bleeding, supporting pain relief, contacting the GP, district nurse, NHS 24 or emergency services, or providing any other appropriate care and support.

6. Emergency Services Contact

Staff must call 999 immediately where a person is unresponsive and not breathing normally, unless a valid and immediately available DNACPR form confirms that CPR should not be attempted. Where a DNACPR form is in place, staff must still call 999, the GP, district nurse, NHS 24 or out-of-hours service where urgent clinical support is required, where death is unexpected, where the person has symptoms requiring urgent treatment, or where staff are instructed to do so by the person’s personal plan or healthcare professional.

Provide clear information on the individual’s condition and any medical history. If resuscitation has been attempted, inform emergency responders about the interventions provided.

Staff must tell the call handler whether a DNACPR form is present, whether it is the original form, where it is located, and whether the person has an Anticipatory Care Plan, Key Information Summary or other emergency care plan. Staff must follow the emergency call handler’s instructions unless doing so would conflict with a valid and applicable DNACPR decision. Staff must remain with the person where safe to do so, maintain dignity and privacy, and support family or relevant others sensitively.

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:

7. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Decisions

Definition

A Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision is a clinical decision, recorded on the national NHSScotland DNACPR form, that CPR should not be attempted if the person has a cardiac or respiratory arrest. The DNACPR form is not legally binding in itself. It is evidence that an advance clinical assessment and decision has been made and recorded to guide immediate decision-making in an emergency.

DNACPR decisions do not mean withholding treatment, care or support. The person must continue to receive appropriate healthcare, personal care, emotional support, comfort care, symptom management, palliative care and emergency treatment where clinically appropriate.

Criteria for DNAR Decisions

A DNACPR decision may be made where:

A person, family member or legal proxy cannot require staff or healthcare professionals to provide CPR where CPR is clinically judged not to be medically successful or clinically appropriate.

8. Capacity and Consent

Adults who have capacity must be supported to make informed decisions about CPR and future emergency care. A person with capacity may refuse CPR, even where CPR may be clinically successful. Their decision should be respected where it is informed, current, made without undue influence and applicable to the circumstances.

Where a person lacks capacity to participate in the decision, staff must follow the Adults with Incapacity (Scotland) Act 2000 principles. Any action or decision taken on behalf of the person must:

Family members, carers and next of kin do not automatically have legal authority to make DNACPR decisions unless they hold relevant powers, such as welfare attorney, welfare guardian or intervention order powers. Their views remain important because they may help clarify the person’s wishes, values, beliefs and what the person would have wanted.

Where the person has a welfare attorney, welfare guardian or other legally appointed proxy with relevant powers, the responsible healthcare professional must consult them as required. If staff are unsure about a person’s capacity, legal proxy, advance directive or DNACPR status, they must seek advice from the registered manager and the relevant healthcare professional without delay.

9. DNACPR Forms, Accessibility and Validity Checks

A DNACPR decision should be recorded on the national NHSScotland DNACPR form. The form is not legally binding in itself, but it is the recognised document used in Scotland to evidence and communicate the clinical decision. The original DNACPR form should be immediately accessible wherever the person is being cared for, including in the person’s own home.

Staff must check and record:

A photocopy must not be treated as the valid form unless a healthcare professional or emergency service gives clear instruction in the circumstances. If only a photocopy is available, the form is unclear, the form appears incomplete, the person’s identity cannot be confirmed, or staff are unsure whether it applies, staff must call 999, explain the situation and follow the emergency call handler’s instructions.

Where a DNACPR decision is reversed, staff must ensure the personal plan is updated immediately and that obsolete copies or references are removed or clearly marked as no longer current, in line with healthcare professional instructions.

10. Responsibilities of Staff

Staff must:

Managers must:

11. Emergency Response Where a DNACPR Decision May Apply

In the event of a medical emergency, staff must remain calm, maintain the person’s dignity and follow the person’s personal plan and this policy.

Where the person is unresponsive and not breathing normally and a valid original DNACPR form is present and clearly applies:

Where no DNACPR form is present, the form is not the original, the form is unclear, or staff are unsure whether it applies:

Where the person is breathing but acutely unwell:

Where choking, anaphylaxis, bleeding, seizure, fall, suspected stroke, suspected sepsis, pain, breathlessness or other acute deterioration occurs:

12. Communication and Family Involvement

Discussing DNAR Decisions

Handling disagreements or concerns

If the person, family member, carer, legal proxy or staff member raises concern about a DNACPR decision, staff must:

Where there is disagreement between family members and the healthcare team, the responsible healthcare professional should lead further discussion. Where appropriate, a second opinion may be sought by the healthcare team. Staff must continue to provide compassionate support and must not allow disagreement to delay urgent emergency action.

Information must be provided in a way the person can understand, taking account of communication needs, language, sensory impairment, cognitive impairment, learning disability, mental health needs, culture, faith, trauma and emotional distress. Advocacy or interpreter support must be considered where this would help the person participate.

13. Staff Training and Responsibilities

All staff must receive training appropriate to their role and responsibilities. This must include:

Staff must not be asked to carry out any task for which they are not trained, competent or authorised. Where staff are unsure, they must seek guidance immediately from a manager, healthcare professional or emergency service.

14. Documentation and Record-Keeping

Accurate record-keeping is essential for safe care, regulatory compliance and accountability. The following must be recorded clearly in the person’s personal plan where applicable:

The personal plan must be updated when a DNACPR decision is made, reviewed, reversed, replaced or becomes unclear. It must also be reviewed when the person’s health, welfare or safety needs change, when requested by the person or their representative, and at least every six months.

Records must be factual, respectful, dated, signed or attributable to the staff member making the record, and completed as soon as possible after the event. Sensitive health information must be stored and shared in line with UK GDPR, the Data Protection Act 2018 and organisational confidentiality procedures.

15. Care Inspectorate Notifications, Incidents and Learning

{{org_field_name}} will follow current Care Inspectorate guidance on records that must be kept and notifications that must be made by adult care services. Managers must ensure that deaths, serious incidents, accidents, injuries, allegations of harm, adult support and protection concerns, medication incidents, staffing concerns, or other notifiable events are reported to the Care Inspectorate where required by the current guidance and within the required timescale.

Following any emergency involving CPR, DNACPR, unexpected death, uncertainty about documentation, disagreement, complaint or concern, the manager must ensure that:

16. Policy Review

This policy will be reviewed at least annually, or sooner if there are changes to Scottish legislation, Care Inspectorate requirements, Scottish Government DNACPR guidance, Resuscitation Council UK guidance, SSSC Codes of Practice, Health and Social Care Standards, local NHS Board procedures, or organisational learning from incidents, complaints, audits or inspections.

The registered manager is responsible for ensuring that the policy remains current, that staff are informed of changes, and that implementation is monitored through supervision, training, personal plan audits and quality assurance processes.

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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