Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Decisions

A DNACPR decision is a medical order that instructs healthcare professionals not to perform cardiopulmonary resuscitation (CPR) if a patient's heart stops or if they stop breathing. The primary purpose of a DNACPR order is to respect the wishes and autonomy of patients who do not want to receive CPR, often due to underlying medical conditions or poor prognosis.

Indications for DNACPR Decisions

• Poor prognosis: Patients with severe, life-limiting illnesses or injuries may not benefit from CPR.
• Advanced age or frailty: Older adults or those with significant frailty may be at higher risk of harm from CPR.
• Severe cognitive impairment: Patients with advanced dementia or other severe cognitive impairments may not be able to make informed decisions about their care.
• Patient preference: Some patients may express a desire not to receive CPR due to personal, cultural, or religious beliefs.

Process for Making DNACPR Decisions

The process for making DNACPR decisions typically involves:

1. Assessment of the patient's medical condition and prognosis.
2. Discussion with the patient, their family, or caregivers about their wishes and values regarding CPR.
3. Documentation of the DNACPR decision in the patient's medical record.
4. Communication of the DNACPR decision to relevant healthcare professionals.

Key Considerations

When making DNACPR decisions, it is essential to consider:

• Patient autonomy: Respect for the patient's right to make informed decisions about their care.
• Beneficence: The potential benefits and harms of CPR in the context of the patient's medical condition.
• Non-maleficence: Avoiding harm or unnecessary suffering.
• Justice: Ensuring that DNACPR decisions are fair, equitable, and free from bias.

Documentation and Communication

A DNACPR decision should be clearly documented in the patient's medical record, including:

• The reason for the DNACPR decision.
• The patient's (or their representative's) agreement with the decision.
• Any relevant medical information or assessments.

Effective communication of the DNACPR decision is crucial to ensure that all relevant healthcare professionals are aware of the patient's wishes and can provide appropriate care.

Review and Revision

A DNACPR decision should be regularly reviewed and revised as necessary, taking into account changes in the patient's medical condition or wishes. This ensures that the decision remains relevant and respectful of the patient's autonomy.