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Resuscitation and DNAR (Do Not Attempt Resuscitation) Policy

1. Purpose

The purpose of this policy is to provide clear guidance on resuscitation procedures and DNAR (Do Not Attempt Resuscitation) decisions within {{org_field_name}} Supported Living Services. This policy ensures that service users receive appropriate, person-centred care, respecting their wishes, legal rights, and clinical best practices, while maintaining full compliance with CQC regulations and relevant legal frameworks.

This policy aims to:

• Ensure staff understand their responsibilities regarding resuscitation and DNAR decisions.
• Provide a structured approach to managing DNAR documentation and decision-making.
• Ensure compliance with the Mental Capacity Act 2005, the Human Rights Act 1998, and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Respect service users’ rights to make advanced care decisions.
• Ensure clear communication between service users, families, and healthcare professionals.
• Provide guidance on emergency responses while ensuring legal and ethical considerations are upheld.

2. Scope

This policy applies to:

• All service users receiving care at {{org_field_name}}.
• All staff members, including support workers, senior carers, and management.
• Healthcare professionals and external medical teams providing care to service users.
• Family members and advocates involved in advanced care planning.

This policy applies to all resuscitation decisions, including cardiopulmonary resuscitation (CPR), DNAR orders, and emergency medical interventions.

3. Legal and Regulatory Framework

This policy ensures compliance with:

3.1 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

• Regulation 9 (Person-Centred Care) – Requires that care is tailored to service users’ preferences and best interests.
• Regulation 11 (Need for Consent) – Ensures that care is only provided with valid consent or in the best interests of the individual.
• Regulation 13 (Safeguarding from Abuse and Improper Treatment) – Ensures that DNAR decisions are not discriminatory and do not deprive service users of appropriate care.

3.2 Mental Capacity Act 2005

• Ensures that service users who have capacity can make decisions regarding DNAR orders.
• Requires best interest decisions for those lacking capacity, following consultation with families, legal representatives, and healthcare professionals.

3.3 Human Rights Act 1998

• Article 2: Right to life – Ensures DNAR decisions are made ethically and without unjustified discrimination.
• Article 8: Right to respect for private and family life – Protects individual autonomy in medical decision-making.

3.4 ReSPECT (Recommended Summary Plan for Emergency Care and Treatment)

• Encourages collaborative decision-making between service users, families, and medical professionals regarding emergency care plans.

4. Understanding Resuscitation and DNAR Orders

4.1 What is Cardiopulmonary Resuscitation (CPR)?

CPR is a life-saving intervention used to restore breathing and circulation when an individual has suffered cardiac or respiratory arrest. It includes:

• Chest compressions and rescue breathing.
• Use of a defibrillator (AED) if required.
• Advanced life support from emergency responders.

4.2 What is a DNAR (Do Not Attempt Resuscitation) Order?

A DNAR order is a legally recognised decision indicating that a person should not receive CPR if they experience a cardiac arrest. However:

• A DNAR does not mean the withdrawal of all other treatments.
• Service users must be fully involved in DNAR decisions, where possible.
• DNAR orders are made in consultation with healthcare professionals, service users, and their families.

5. Implementing DNAR Decisions at {{org_field_name}}

5.1 Identifying and Recording DNAR Orders

• All DNAR decisions must be clearly documented in the service user’s care plan.
• DNAR forms must be signed by a qualified medical professional (GP or consultant).
• The form must be kept in an accessible but confidential location within the care records.
• Staff must be informed about the DNAR order but must maintain confidentiality.

5.2 Reviewing DNAR Orders

• DNAR orders must be reviewed regularly, particularly if:
  • The service user’s health condition changes.
  • The service user expresses a desire to revoke or amend the DNAR.
  • A family member or legal advocate requests a review.
• Reviews must be documented and signed by a senior clinician.

5.3 Staff Responsibilities

• Staff must not assume a DNAR order exists unless it is documented and verified.
• In an emergency, if no DNAR order is present, staff must initiate basic life support and call emergency services.
• Staff must follow the latest DNAR documentation provided by healthcare professionals.

6. Emergency Response Procedures

6.1 If a DNAR Order is in Place

• Verify the presence of the DNAR form.
• Provide comfort care and palliative support, ensuring the service user is comfortable.
• Inform emergency services of the DNAR order if medical intervention is needed.
• Notify the service user’s next of kin or legal advocate immediately.
• Document all actions in the care records.

6.2 If No DNAR Order is in Place

• Initiate CPR immediately.
• Call 999 for emergency medical assistance.
• Continue resuscitation efforts until:
  • A qualified emergency responder arrives.
  • A doctor confirms that resuscitation should be discontinued.

7. Training and Staff Awareness

7.1 Mandatory DNAR and Resuscitation Training

• All staff must undergo annual training on DNAR orders, CPR, and emergency response protocols.
• Training includes:
  • How to recognise and follow DNAR decisions.
  • When to initiate or withhold resuscitation.
  • How to provide palliative and comfort care in end-of-life situations.

7.2 Communication and Confidentiality

• Staff must handle DNAR discussions with sensitivity, empathy, and professionalism.
• DNAR orders are strictly confidential and must only be shared with relevant personnel.

8. Monitoring and Compliance

• Managers and senior care staff will conduct quarterly audits to ensure all DNAR orders are up-to-date and correctly documented.
• CQC inspections will review DNAR compliance as part of Regulation 9 (Person-Centred Care) and Regulation 11 (Need for Consent).
• Service user feedback and complaints related to DNAR decisions will be investigated and addressed promptly.

9. Policy Review

This policy will be reviewed annually or sooner if:

• There are changes in national guidelines on DNAR and resuscitation.
• Service user feedback suggests improvements are needed.
• New legal precedents or case law affect DNAR decision-making.

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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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