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What is a DNR/ DNACPR? 
 
A ‘do-not-resuscitate’ (DNR) order, also sometimes referred to as a ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) order, is a medical order that is written and issued by a doctor. It instructs healthcare providers not to do cardiopulmonary resuscitation (CPR) if the person under there care, goes into respiratory or cardiac arrest. 
 
What is CPR? 
 
CPR stands for cardiopulmonary resuscitation, a treatment that is given when someone goes into respiratory arrest (where they stop breathing) or when someone goes into cardiac arrest (where their heart stops beating and pumping blood around the body). 
CPR attempts to get your breathing or heart started again. 
 
CPR can involve- 
 
• pressing down hard on the chest repeatedly, otherwise known as chest compressions 
• electric shock to restart the heart with a device called a defibrillator 
• breathing tubes inserted to open the airway and move oxygen around the body 
• giving medication via an injection 
 
How successful is CPR? 
 
CPR can sometimes get the heart and breathing restarted again, the quicker that CPR is administered from the moment someone goes into cardiac or respiratory arrest, the better chance that they might have of survival. 
 
Other factors that would increase chances of CPR being successful are- 
 
• healthy lungs, heart and organs 
• the person administering CPR is trained 
• an ambulance is called and arrives as soon as possible 
• equipment, such as defibrillators are used in administering CPR 
 
Overall, CPR restarts the heart and/or breathing for between 1 and 2 in 10 people whose heart or breathing have stopped. 
 
CPR is often less successful on people who have poor health of the heart, lungs or other organs, this may be due to- 
 
• previous heart, lung, or organ damage, from things such as smoking 
• having a serious long term health condition, like asthma or diabetes 
• having a current severe illness, such as cancer or heart disease 
• being frail, from things like ageing or recent illness 
• approaching the end stages of your life 
 
CPR does take a physical toll on the body, CPR such as chest compressions can cause significant bruising, broken ribs and even punctured lungs. Only very few people make a full recovery even if their heart or breathing can be restarted with CPR. You may still be very unwell and need more treatment, never getting back to the health you once had before. 
 
Your heart and/or brain may be permanently damaged from the lack of oxygen and/or blood circulating throughout your body, and broken bones or punctured lungs from CPR may never fully recover or heal properly, leaving you in severe pain or suffering. 
 
A DNR/DNACPR form may be written by a doctor to prevent someone from receiving treatment that would prolong or cause suffering at the end of their life, the person can still be given other treatments to keep them pain free and as comfortable as possible. 
 
 
What does DNR/DNACPR mean and how is it recorded? 
 
DNACPR stands for do not attempt cardiopulmonary resuscitation, it is also sometimes referred to as a DNAR (do not attempt resuscitation) or DNR (do not resuscitate) but they all refer to the exact same thing. 
 
DNACPR means if your heart or breathing stops, those who you are under the professional care of, will not attempt to restart it. 
 
A DNACPR decision is made by you and/or your doctor or the healthcare team in charge of your care. This decision is usually recorded on a special form, all these forms are easily recognised by doctors, nurses and healthcare workers, so they know what to do in an emergency. This form is kept in your medical records and may also be printed to be kept with you and in your home. 
 
It is important to be aware if you have a DNACPR form on your medical records and informing people that are important to you, that it is in place, as if you were to go into respiratory or cardiac arrest, medical staff will not step in to restart your heart, leading to your death and the potential confusion and distress of your loved ones at the time. 
Who participates in a DNACPR decision? 
 
Anyone can ask for DNACPR to be recorded on their medical records if they have the capacity to make such a decision. This is a decision you can make at any time, whether healthy or approaching the end of your life. 
 
To have it recorded, approach your GP, Doctor or the Medical team in charge of your care with your decision, they will then fill out a DNACPR form to indicate this and put it on your medical records. 
 
If you wish for your decision to be made legally binding for when in future you are unable to make such a decision, you should complete an Advance Decision to Refuse Treatment (ADRT). An ADRT explains to medical staff when you want to refuse CPR or other treatments. 
 
It is important to remember that you can change your mind about a DNACPR decision at any time, if you do change your mind, you need to inform your GP, Doctor or Medical team, so that the form is marked as no longer valid. 
 
A DNACPR decision can also be made by your doctor even if you do not agree, you must be told about the decision, but a doctor does not need your consent, the only reason they may not inform you is if they think in doing so would cause physical or psychological harm. You should be given the chance to understand what a DNACPR is, how the decision is made and why they think CPR would be inappropriate for you. 
 
You should be consulted and a discussion between you and the doctor should take place so that you can express your wishes and thoughts, but ultimately the decision is down to the doctor, and a doctor does not have to carry out any treatment that they believe will not work. 
 
If you disagree with a DNACPR decision you can ask for a second opinion and a review, however you cannot demand CPR and the law does not require your consent, it only provides you with the right to be involved in the decision-making process and informed of a doctor’s DNACPR decision. 
What if you are unable to make or discuss a DNACPR decision yourself? 
 
Some people are not able to make decisions about CPR themselves, if you have been assessed and deemed unable to decide yourself, you will be referred to as ‘lacking capacity’. If you are considered to lack capacity, the first thing a medical team should do is to check if you have an ADRT, that says that you do not want this form of treatment. They should also check if you have a Lasting Power of Attorney (LPA) for health and care decisions. 
 
An LPA is a document that outlines a person that you have chosen to make decisions on your behalf, if the section on life-sustaining treatment has been completed and signed, with an LPA your ‘attorney’ can make the decision about CPR in your best interests. 
 
If neither an ADRT or LPA are in place, then a senior doctor will make decisions on your behalf, the doctor must ask people who are important to you about your wishes and preferences, including anyone with legal power to represent you, such as a welfare team, special guardian or a parent, for children under the age of 16. 
 
If there is no one appropriate to ask, then the doctor should ask an independent mental capacity advocate (IMCA) to represent you in the decision-making process or ask members of your healthcare team for their views. 
 
What should you do if you are worried about a DNACPR form on your medical record? 
 
If you are not sure why the decision has been made to place a DNACPR on your medical record, then you should ask the doctor to explain the reasoning behind there decision. If you still disagree with the doctor’s decision, then you can ask for a second opinion. 
 
If you lack capacity, getting friends or family, or someone with legal power to represent you, such as your LPA can raise these concerns on your behalf. 
 
It can be upsetting to find out that a doctor has decided that CPR is not medically appropriate treatment for you or for a relative to receive, for many people this conversation can come as a surprise and be rather upsetting, but if a doctor makes this decision or brings up the conversation, it usually means they believe that CPR would cause you more harm than good. 
 
Unfortunately, these decisions don’t always get explained very well and while the doctor may have good reason, they may have not communicated their decision with you properly. It is important to understand that no one has the right to ask for CPR, so the decision may not change, if there is good medical reasoning behind it. A doctor should always ensure that they explain their choice, ask for your wishes and preferences and make their choice on individual assessment. 
 
If you wish to complain about such a decision, then you can follow the practice or hospitals complaints procedure, or you can contact NHS England or even your local Healthwatch. 
 
Further to this, if you are unhappy with their response, you can contact the Parliamentary and Health Service Ombudsman. 
 
If you would like to read further into DNACPR and the decision process, please follow this link to the NHS website. 
Services we provide 
 
Academy Care are a passionate domiciliary care company who support individuals, whom for reasons of ill health or disability, can benefit from long or short-term domiciliary care services in the comfort and familiar surroundings of their own home. At Academy Care we are committed to ensuring that all our clients receive the very best care, promoting your independence and supporting you to maximise your quality of life and wellbeing. We pledge to deliver quality, bespoke and affordable care, in a dignified, responsive and personal manner. At Academy Care, your care is our passion. 
 
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