Yorkshire & Humber Regional Form For Adults And Young People Aged 16 And Over (Page 2 of 2) in pdf

These guidelines are based on an agreement within the Yorkshire and Humber region.

This form can be red or black-bordered.

For more details refer to your local policy relating to DNACPR.

This is not a legally binding document; the decision may change according to clinical circumstances

Section 1

Guidance

(Please write legibly and with black ink)

Option A

Record details in the patient‟s notes, including the assessment of the patient‟s mental capacity to make this decision.

Option B

The Mental Capacity Act (2005) confirms that an advance decision refusing CPR will be valid and therefore legally binding

on the healthcare team, if:

The decision is in writing, signed, witnessed and the patient is aged 18 or over;

It includes a statement that the advance decision is to apply even if the patient‟s life is at risk;

The advance decision has not been withdrawn;

The patient has not, since the advance decision was made, appointed a welfare attorney to

make decisions about CPR on their behalf;

The patient has not done anything clearly inconsistent with its terms; and

The circumstances that have arisen match those envisaged in the advance decision.

16 and 17-year-olds: Whilst 16 and 17-year-olds with capacity are treated as adults for the purposes of consent, parental responsibility

will continue until they reach age 18. Legal advice should be sought in the event of disagreements on this issue between a young person

of 16 or 17 and those holding parental responsibility

Option C

The term “overall benefit” is used in the context defined by GMC Guidance 2010 (Treatment & Care towards the

End of Life; pg. 40-46; paragraphs 6, 13) and takes into account “best interests” as defined by the Mental

Capacity Act, 2005.

Whenever possible, this situation must be discussed with relevant others before completing the form. Record

details of your discussion in the patient‟s notes.

The term “relevant others” is used to describe a patient‟s relatives, carers, representatives, people with lasting

power of attorney, independent mental capacity advocates (IMCAs), advocates, and court appointed deputies

(refer to Mental Capacity Act)

Option D

Record underlying condition/s (e.g. poor Left Ventricular Function, End stage obstructive airway disease,

disseminated malignancy) and complete necessary discussions with patient and/or relevant others as soon as possible

Review – In accordance with your Local Policy

Section 2

It is considered good practice to review DNACPR status in the following circumstances:

 At the consultant ward round, MDT or Gold Standards Framework meeting;

 On transfer of medical responsibility (e.g. hospital to community or vice versa); or

 Whenever there are significant changes in a patient‟s condition.

Cancellation of DNACPR: When the form is no longer valid, either because the patient is for CPR or because a new form

has been completed, it must be marked as cancelled by making two thick, dark, diagonal lines across the form, writing

CANCELLED in large capitals and adding your signature and date. It should then be filed in the patient‟s notes.

Section 3

Authorisation

Responsibility for making the DNACPR decision lies with a senior doctor (e.g. Consultant, GP) who has responsibility for

the patient. In some localities, other healthcare professionals who have undertaken the necessary training may make the

DNACPR decision.

Countersignature: If junior medical staff or other authorised professionals have been instructed to sign the form by a

senior clinician, the form should be countersigned by the senior doctor, as soon as possible or as per local policy.

Any supplementary information (e.g. family informed by nursing staff at later stage) should be signed and dated by the

entry.

COMMUNICATING DNACPR DECISIONS

It is the responsibility of the healthcare team completing the form to ensure that the DNACPR status is communicated to all

who need to know.

For patients being transferred between different care settings, it is essential that:

Where patients are being transferred to community (e.g. home or care home): the DNACPR status and an explanation

of the role of the form in an emergency should be communicated to patient (if appropriate) and „relevant others’.

Send the original form with the patient. A photocopy or carbon copy version should be retained in the patient‟s notes

for audit, marked with the words „COPY‟ in large capitals, signed and dated.

v13 January 2014

For discharges to community settings: communicate to the GP,

Regional Review Date: January 2017

Regional Lead Contact: Palliative Medicine Consultant

Out of Hours service and any other relevant services as appropriate.

Calderdale & Huddersfield NHS Foundation Trust, West Yorkshire

Yorkshire & Humber Regional Form For Adults And Young People Aged 16 And Over Page 2

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