New guidance on cardiopulmonary resuscitation makes it clear clinicians should talk to frail patients about whether to attempt it at the earliest opportunity, despite recent concerns these conversations were not being handled sensitively.
The updated CPR guidance, issued by the British Medical Association, Resuscitation Council and the Royal College of Nursing, emphasises the value of making decisions about whether to attempt CPR in advance of a crisis where possible.
But it stresses these conversations should be undertaken by “healthcare professionals with the necessary training and expertise”, and carried out in a “sensitive but realistic manner”.
“For many people with advanced or multiple medical conditions the optimal time to undertake advance care planning is when they are relatively stable, in their home or usual care environment, where it can be supported by the healthcare professionals who know them well,” the guidance states.
“These may include doctors and nurses based in general practice, in the community, in hospices and in hospitals,” it adds.
“In working together to improve this guidance, doctors and nurses are helping ensure these difficult situations are managed in a way which does not add to the distress and confusion of patients and their loved ones”
The guidance comes amid media reports that some sick and older patients were being left upset and confused, having been unexpectedly quizzed on end of life wishes by unfamiliar professionals, including district nurses.
Patients have also complained about getting phone calls out of the blue from practice nurses asking about resuscitation.
The guidance said discussing or explaining CPR decisions early on helped ensure patients’ wishes were respected and reduced the risk of them having treatment they did not want.
It also acknowledged that these conversations could be “difficult” for healthcare professionals, especially when it came to informing patients and relatives about do not resuscitate orders.
But it made it clear that where CPR had no realistic chance of success then a do not resuscitate order was entirely valid.
“Situations that involve attempts to resuscitate patients are among the most difficult for all concerned,” said RCN chief executive and general secretary Peter Carter.
“What this new edition of the guidance makes clear is that with good, sensitive communication from staff, individuals can plan, make their wishes known and understand the consequences of decisions around resuscitation,” he said.
“In working together to improve this guidance, doctors and nurses are helping ensure these difficult situations are managed in a way which does not add to the distress and confusion of patients and their loved ones,” he added.
The guidance makes it clear that ultimate responsibility for a CPR decision rests with the most senior healthcare professional caring for a patient, which could be a consultant, GP or senior or specialist nurse.
However, it also said there may be situations where another member of the team is best-placed to discuss these issues with the patient or their loved ones, such as a nurse involved in their day-to-day care.
The revised guidance also stressed the need for effective communication of decisions to other healthcare professionals in primary and secondary care, including ambulance clinicians and staff at residential and care homes, and careful documentation.
“The senior nurse is responsible for ensuring that every CPR decision is recorded in the nursing records (where the institution has separate nursing records), that those records are updated should the decision change and that all those nursing the patient are aware of the current decision,” said the document.
- Read the guidance on Decisions Relating to CPR