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New guidelines on patient resuscitation for Scotland

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National policy on do not attempt cardiopulmonary resuscitation (DNACPR) for adults in Scotland has been updated, with an emphasis on open discussion with patients and relatives.

It follows a review of both adult and children’s policies in order to reflect changes in national good practice guidance, said the Scottish government.

“The option of a dignified death must be open to everyone in all circumstances”

Maureen Watt

The update emphasises the importance of engaging with patients and their families about CPR decision-making in the “context of the goals of care, realistic treatment options and choices”.

Where CPR will not help and may cause harm and distress for the patient and their family, the policy states that there should be a “presumption in favour of informing patients of a DNACPR decision”.

“This information should always be shared sensitively in the context of exploring their goals of care and wishes around realistic emergency treatment options,” stated the guidance.

Other key points in the updated guidance concern when CPR will not be successful and a DNACPR decision has been made and documented.

The “only justification for not sharing this information” with a patient is where they lack capacity to engage with the conversation, in which case the information must be shared with the welfare attorney/guardian or relevant others as soon as possible, the patient refuses to engage or it is judged that the conversation would “cause the patient physical or psychological harm”.

The updated document also said that, where a clinical team is as certain as it can be that CPR will not be successful and that the patient is irreversibly deteriorating, the DNACPR decision “will remain appropriate until the patient’s death and does not need reviewed”.

But senior clinicians taking over clinical responsibility for the patient – transfer or discharge to a different team – should still review the decision and document that they are in agreement, it added.

Maureen Watt, Scottish minister for mental health, launched the updated policy today during a visit to health and wellbeing charity the Thistle Foundation.

Ms Watt said: “I’m pleased to be able to launch this updated policy as part of our efforts to ensure that palliative and end of life care is delivered to a high standard, in every situation, right around the country.

Scottish Government

Maureen Watt

Maureen Watt

“Whether or not to attempt CPR towards the end of someone’s life is one of the most emotive and sensitive decisions that patients, doctors and relatives will ever have to face and this policy identifies the key importance of conversations with patients and families,” she said.

“Supporting staff in all health and social care settings to have these sensitive discussions is of the utmost importance,” said Ms Watt.

“Treatment options must be discussed honestly and the patient’s wishes must be taken into account where possible. The option of a dignified death must be open to everyone in all circumstances,” she added.

This updated policy reflects changes in national good practice guidance published in 2016 by the British Medical Association, the Royal College of Nursing and the Resuscitation Council (UK).

The chief medical officer and chief nursing officer for Scotland will be writing to health boards informing them of the updated policy and offering helpful resources for staff, patients and families.

The policy for children and young people will be updated later in the year.

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