1. Do Not Attempt Cardio Pulmonary Resuscitation – (DNACPR) and Mental Capacity – (MCA) Completion
Tracy Reed
Education Facilitator for End of Life Care
EPUT

2. What Will Be Covered Burdens and risks of CPR
Likelihood of success of CPR
Burdens and risks of CPR
Who should we be talking to about DNACPR
Barriers to making DNACPR decisions and Legal Factors
How to start the conversation
Mental Capacity and Best Interest Decisions

3. Likelihood of success of CPR
Dependent on:
The cause of cardiac or respiratory arrest
The underlying health of the victim
The time elapsed between the arrest and CPR
The technique used by the person performing CPR
Where the arrest takes place
Percentage outcomes:
2% to 30% effectiveness when administered outside of the hospital
6% to 15% for hospitalized patients
Less than 5% for elderly victims with multiple medical problems

4. GMC - burdens and risks of CPR
Rib fracture and damage to internal organs
Hypoxic brain damage
Increased physical disability
Undignified and traumatic death
Family not aware of risk of death

5. Who should we be talking to?
Patients with terminal illness
Patients with multiple pathology
Patients at advanced age
As part of advance care planning in patients with dementia

6. Barriers to Making DNACPR Decisions and Legal Factors GMC 2010
You should not withhold information simply because conveying it is
difficult or uncomfortable for you or the healthcare team
Addenbrookes v Tracey
When patients challenge our decision they have the right to a
second opinion
IMCA involvement needed if no significant other
Medical decision and BMA Guidelines:
Decisions not to resuscitate should depend on:
The likely clinical outcome - likelihood of success and overall benefit from a successful resuscitation
The patient’s known, or ascertainable, wishes
The patient’s human rights
The right to life
The right to be free from degrading treatment
Views of all members of the medical and nursing team including people close to the patient should be sort

7. How to start the conversation
Not in isolation
Start with what you are going to do first
Discuss patients understanding of their condition and assess their capacity
Any advance directives/ community forms?
If lack capacity seek opinion of NOK in same way

8. Specific Outcome in the Context of The Mental Capacity Act (2005)
Advance Care
Planning
Advance
Statement
Decisions
To Refuse
Treatment
Lasting Power Of
Attorney

9. Best Interest Decision Making
The Mental Capacity Act (MCA) states that if a person lacks mental capacity to make a particular decision then whoever is making that decision or taking any action on that person’s behalf must do this in the person’s best interests. This is one of the principles of the MCA. A lack of capacity must have been established as a result of assessing the person’s capacity in accordance with the MCA and its Code of Practice.

10. Best Interest
Where a decision is about treatment or resuscitation,  a doctor has to act as a decision maker. The doctor has to follow any advance care plan and should consult with all relevant people (as practicable) who could be interested in the specific decision (carers, family members,  friends, other health care professionals, social care, IMCA, LPA etc.)
To enable them to understand patients beliefs, wishes and views even if the patient now lacks capacity.
It is best practice to record MDT involvement in these discussions.
Record discussions in the medical notes and document on the DNACPR form as your evidence of how the decision is made.

11. Decision under MCA If you are making the decision under the Mental
Capacity Act you must take the above steps, amongst
others and weigh up the factors in order to determine
what is in the person’s best interests. For more information
you should refer to the Code of Practice.
MCA forms and information can be accessed via:
Essex safeguarding Adult Board’s website:
You can also contact your: Adult Safeguarding Team
West Essex CCG –   

13. Princess Alexandra Hospital DNACPR Process and Treatment Escalation Plans –TEP Update
Sarah Jones, Ceilings of Treatment Nurse Advisor
Matthew Ibrahim, Resuscitation Officer

18. ‘How people die remains in the memory of those who live on’
Dame Cecily Saunders
Founder of the Modern Hospice Movement

19. SURVEY

20. resources
Royal College of General Practitioners (RCGP): End of life care
GMC: Treatment and care towards the end of life: good practice in decision making
Gold Standards Framework (GSF)
Prognostic Identification Guidance
Essex safeguarding Adult Board’s website:
End of Life Care for All
Dying Matters
Information for patients 
Planning for Your Future Care
NHS Choices: End of life care
NHS Choices: Carers and end of life care
East of England Patient information Leaflet
Training and development 
e-ELCA training in advance care planning; assessment; communication; symptom management, comfort and well-being
East of England DNACPR e-learning
Dying Matters DNACPR

22. https://youtu.be/In4h4jCqQ8o