The aim of our review is to consider the practices in place when DNACPR decisions are applied to adult patients (over the age of 18), and whether patient views and considerations are respected.
We considered whether DNACPR decisions reflect the priorities of the individual, as well as their preferred information requirements, and whether a DNACPR decision is clearly recorded and communicated between healthcare professionals, and with the patient and those close to them.
Our research and stakeholder engagement helped inform the scope of our work, of how to answer the question:
- Are DNACPR decisions being respectfully communicated to patients and those close to them, and are they clearly recorded and communicated between healthcare professionals?
Our key lines of enquiry included:
- Is DNACPR documentation in medical records (and not just the DNACPR forms) robust?
- Does the DNACPR documentation appropriately reflect the communication with patients, and with those close to the patient?
- Is there evidence of communication of a DNACPR decision across different healthcare teams?
- How do clinicians consider the communication needs of people to ensure they fully understand the DNACPR decision making process?
- What measures do healthcare organizations have in place to ensure clinicians consider equality and diversity when making DNACPR decisions?
The review explored whether patients are actively involved in decision making about DNACPR and whether those decisions are clearly recorded and communicated between healthcare professionals. Our findings highlight clear examples of noteworthy practice across Wales, however, there is room for improvement. In particular, we found there is a need to strengthen communication about DNACPR decisions across healthcare teams, and with patients and their loved ones, to ensure people fully understand the reasons for the decision and the plans about care.
The full report and terms of reference for the review are attached below. We have also developed a summary of our findings.