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* Recommended standards for recording
      "Do not attempt resuscitation" (DNAR) decisions

 
 
These guidance notes have been produced to help healthcare workers and organisations to achieve uniformly high standards in making DNAR decisions and in ensuring that all relevant aspects of these decisions are recorded and communicated to others effectively. They are not intended to be a comprehensive guide to decisions about cardiopulmonary resuscitation (see “Decisions Relating to Cardiopulmonary Resuscitation. A Joint Statement by the British Medical Association, Resuscitation Council (UK) and the Royal College of Nursing” 2007 and “Withholding or Withdrawing Life Sustaining Treatment in Children: A Framework for Practice, Second Edition”. Royal College of Paediatrics and Child Health, 2004).

Whilst identifying minimum requirements for good practice in recording DNAR decisions, the Resuscitation Council (UK) recognises that there may be some minor variation in the documentation requirements according to local circumstances. Two model DNAR forms have been provided for illustration, one for adult and one for paediatric use, and may be adapted to meet local needs by individual healthcare organisations. DNAR decisions may apply and be made in a variety of settings including hospitals, patients’ homes, nursing homes, hospices, and during transfer between these settings. Because of differences in the law, in particular regarding capacity, these forms have been prepared for use in England and Wales in the first instance. Minor modification will be needed to allow use of a similar design of form in Scotland and in Northern Ireland.

These notes refer only to DNAR decisions and it is emphasised that those decisions apply only to attempted cardiopulmonary resuscitation and do not imply that any other aspect of treatment will not be provided.

As an integral part of their resuscitation policy, all healthcare organisations should therefore ensure:

  1. Effective recording of DNAR decisions in a form that is recognised by all those involved in the care of the patient.
     
  2. Effective communication and explanation of DNAR decisions where appropriate with the patient.
     
  3. Effective communication and explanation of DNAR decisions where appropriate and with due respect for confidentiality with the patient’s family, friends, other carers or other representatives.
     
  4. Effective communication of DNAR decisions between all healthcare workers and organisations involved with the patient.
To facilitate this and to facilitate audit it is recommended that DNAR decisions are recorded on a standard form. The two suggested models (adult and paediatric) are provided below. Each form has a set of guidance notes to assist with completion. These could be printed on the reverse of the form or on a sheet that accompanies each form.

Each model form includes a solid red border around its edges. This is to allow it to be recognised easily and located rapidly in a patient's health record. If the form is printed using a laser printer the red border may not extend to the edges of the paper.

It is recommended that the DNAR order should travel with the patient whenever possible and appropriate and should be recognised and accepted by all healthcare services. If healthcare organisations require copies of the DNAR order for audit or records purposes it is recommended that each form is available in duplicate or triplicate with non-carbon copies that are a different colour and that have different printed wording to reflect their purpose, so that only the original (top) copy can be identified as a DNAR order.
 
 
  For adults, for use in England and Wales:
          
Model DNAR form  
           Guidance notes  for completion of model form 

  For children under 16 years, for use in England and Wales:
           Model DNAR form  
           Guidance notes  for completion of model form 
 
 
 
 
 

Page last updated 3 July 2009

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