Adult policy updated.
National policy on DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) for adults in Scotland has been updated.
It follows a review of both adult and children’s policies in order to reflect changes in national good practice guidance. The new adult policy is consistent with those changes, while the policy for children and young people will be updated later in the year.
The update emphasises the importance of engaging with patients and their families about CPR decision-making in the context of the goals of care, realistic treatment options and choices. Where CPR will not help, and may cause harm and distress for the patient and their family, the policy states that there should be a presumption in favour of informing patients of a DNACPR decision.
Minister for Mental Health, Maureen Watt launched the updated policy during a visit to health and wellbeing charity, the Thistle Foundation.
Ms Watt said:
“I’m pleased to be able to launch this updated policy as part of our efforts to ensure that palliative and end of life care is delivered to a high standard, in every situation, right around the country.
“Whether or not to attempt CPR towards the end of someone’s life is one of the most emotive and sensitive decisions that patients, doctors and relatives will ever have to face and this policy identifies the key importance of conversations with patients and families. Supporting staff in all health and social care settings to have these sensitive discussions is of the utmost importance.
“Treatment options must be discussed honestly and the patient’s wishes must be taken into account where possible. The option of a dignified death must be open to everyone in all circumstances.”
Ms Watt was joined at the Thistle Foundation by Dr Beena Raschkes, a GP whose husband, Colonel Sam Rawlinson was diagnosed with a malignant brain tumour in June 2015. He died in March 2016.
Dr Raschkes said:
“Sam and I were able to discuss the difficult subject of resuscitation, if a cardiac arrest occurred, and he stated that he did not wish to be resuscitated. This was an active decision taken as part of an evolving event, and his decision was recorded and shared.
“Patients like Sam who have asked not to be resuscitated will continue to be investigated, treated and cared for to the highest possible standard. If their clinical condition improves their choice may change, so continuing conversations are essential.
“I feel that both personally, and professionally as a GP, it is important to ensure and encourage all those whose health might deteriorate, and their families, to make sure they benefit - as we did - from having a DNACPR decision formally recorded and shared.”
The updated policy can be found here.
This updated policy reflects changes in the national (UK) Good Practice Guidance (“Decisions relating to CPR” revised 3rd edition) published in 2016 by the British Medical Association, the Royal College of Nursing and the Resuscitation Council (UK). The review confirms the General Medical Council Guidance, as well as taking account of legal changes resulting from recent case law.
In conjunction with the review, Healthcare Improvement Scotland has been testing and has now finalised an improvement measurement framework to help measure compliance and improvement to achieve the good practice set out in the policy.
The Chief Medical Officer and Chief Nursing Officer will be writing to health boards informing them of the updated policy and offering helpful resources for staff, patients and families.