All Wales DNA/CPR Policy

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All Wales DNA/CPR Policy

• The story so far.

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Outcomes

• The Context - Where have we come from?
• Where are we now?
• What will happen in the future?
• Any questions?

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The Context
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Where have we come from?

• Elizabeth Kubler Ross On Death and Dying 1969
• The more we are making advancements in science
  the more we seem to fear and deny the reality of
  death

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Before the Policy

• Do Not Attempt Cardio-Pulmonary Resuscitation
  (DNACPR) decisions were being made
• Each organisation, service, hospital etc. had
  their own unique policy and documentation
• Documented decisions not to attempt CPR on
  service documentation were not always valid or
  accepted across service boundaries.
• Critical incidents occurred

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The Process

• Clinicians from across Wales, supported by
  various experts, stakeholder and led by Dr Paul
  Buss, Aneurin Bevan Health Board have worked over
  a period of time to develop an all Wales Do Not
  Attempt Cardiopulmonary Resuscitation policy.

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Were are we now?

• Initial consultation process closed on Wednesday
  11th June 2014
• The new All Wales Do Not Attempt Resuscitation
  Policy is due to be sent to medical directors on
  October 14th 2014
• The introduction of the policy will include
  dissemination of patient information leaflets

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What does the Policy Cover?

• CPR Cardiopulmonary Resuscitation
• CPR is a technique used to maintain bodys
  circulation and breathing. It is a process that
  usually means pressing the chest and providing
  ventilation to the lungs. In some cases
  defibrillation using electric shocks and the
  also injections of medication may be used.

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What is not covered?

• DNACPR
• This refers to a specific decision NOT to provide
  CPR in the event of a cardiac arrest. It must be
  made clear to all that a DNACPR decision does NOT
  impact on any other element of care.

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The Background

• The purpose of the policy is to provide a policy
  framework for professionals and NHS bodies in
  Wales in order to enable a consistent approach to
  decisions relating to the provision of CPR.

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The Aim and Purpose

• Whilst for every individual, death is inevitable,
  achieving a dignified, sensitive and shared
  approach to reaching a decision relating to CPR
  is vital for patients and those who are close to
  them.

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The Risk

• Developing an all Wales Policy doesnt guarantee
  improved communication and involvement in
  discussions
• This can only be achieved through education and
  emphasis on the priorities for implementation of
  the policy

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Who decides about CPR?

• You, or your LPA health and the healthcare team
  looking after you can discuss if you would be
  likely to benefit from CPR. With you they will
  take into account
• Your wishes
• Your current health
• Whether CPR is likely to restart your heart and
  breathing, and for how long
• Also whether CPR will help you live longer in a
  way you can enjoy.
• If your healthcare team think CPR may work for
  you, they will want to know what you think. Your
  wishes are very important in making this decision.

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Who decides about CPR?

• If your healthcare team are sure CPR wont work,
  they may decide in advance that it should not be
  tried.
• They will write this decision on a form called
  Do Not Attempt Cardiopulmonary Resuscitation (a
  DNACPR form).
• They often will wish to discuss this with you and
  the DNACPR form will be kept with your health
  records.

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What influences the decision?

• CPR does not always work. In fact the chance of
  CPR resuscitating you will depend on
• Why your heart and breathing has stopped
• What illness or medical problems you have (or
  have had in the past)
• Your general health

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The Future

• Honest, and regular communication is key to
  implementation

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Consider.

• Communication as a two-way process
• What would you want to know?
• Are there ever any circumstances when you would
  not want to be given information?
• How would your health care professional know your
  choices

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The Future

• Information needs to be-
• Accessible
• In appropriate formats
• Honest
• In terms of the likelihood of successful
  resuscitation
• In terms of the legal standing of individual
  choice

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Information Resources
Available in both Welsh and English
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Final thoughts

• Talking about our wishes doesnt make them happen
  sooner
• Planning for our future care keeps us involved in
  the decision making
• Dying Matters Lets talk about it!

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Source for further Information

• http//www.wales.nhs.uk/sitesplus/861/page/73643
  - (link to draft documentation)
• http//www.wales.nhs.uk/sitesplus/867/opendoc/2401
  98 - (Quick reference guide)
• Wales NHS web-site

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Thank you

• Any questions?