Objective: To devise a unit protocol for decisions relating to cardiopulmonary resuscitation of young patients with chronic neurological illness.
Background: Decisions about attempting resuscitation raise sensitive and potentially distressing issues. In Scotland, the Adults with Incapacity Act 2000 states that where a patient lacks capacity, the doctor has the authority to act in their patients best interests. Current UK guidelines advise that decisions about CPR are made in advance as part of overall care planning. Literature suggests that a doctor’s perception of a patient’s quality of life may influence CPR decisions. Quality of life may be underestimated in this group of patients. Doctors are more likely to accurately predict a patients CPR preference by good communication with patients and or those who know them best.
Subject and Methods: 20 inpatients with chronic neurological disease requiring long-term hospital care. Aged 22 - 62 years. 12 were male, 8 female. 13 lacked capacity due to cognitive impairment. Multidisciplinary case notes were reviewed, a survey of nursing staff completed and current practice compared with latest guidelines and literature.
Results: CPR had been discussed with 2/20 patients. Both had DNAR (do not attempt to resuscitate) orders made in the context of acute illness. Decisions were documented legibly, signed and dated and discussed in both cases with family and in one with the patient. 15 questionnaires were completed, 12 nurses knew which patients on the ward had DNAR orders. 13 felt CPR should be discussed routinely.
Conclusions: CPR should be discussed routinely rather than only in the context of an acute life-threatening illness. Discussion should involve the patient where possible and or those who know them best. When decisions about CPR are made on a patient’s behalf, an Adults with Incapacity form should be completed.