updated November 2007
The British Medical Association (BMA), the Royal College of Nursing (RCN) and
the Resuscitation Council (UK) have issued new guidance on decisions about attempting to
resuscitate patients when their hearts stop or if they stop breathing. Reference to the Mental Capacity Act
has been included to cover decision-making for patients who lack capacity.
Following misleading press coverage, some confusion has arisen about two statements in the document
relating to the role of senior nurses in making decisions about cardiopulmonary resuscitation (CPR).
The statements appear in sections 6 and 13 of the document. Erroneous reporting led to some concerns
that doctors' opinions could be superseded, patients insufficiently consulted or that
inexperienced nurses might make such decisions. Consideration of the statements
in the context of the entire document makes clear these are misinterpretations.
Healthcare is increasingly multi-disciplinary and the document is designed to be used in a variety of contexts,
including where healthcare teams are led by nurses. It makes clear that responsibility for decision-making and CPR
must always rest with the most senior clinician in charge of a patientís care. In the majority of cases
this will be a registered medical practitioner but in some situations, such as in nurse-led palliative care services,
a senior nurse with appropriate training may fulfil this role, subject to local discussion and agreement.
The document states that if there is genuine doubt or disagreement about whether CPR would be clinically appropriate
a further senior clinical opinion should be sought.
The guidance stresses that although the responsibility for decision-making rests with the most senior clinician,
these decisions should not be made in isolation, but where appropriate, should involve the patient
(or those close to the patient if s/he lacks capacity) and others involved in the clinical care of the patient.
Teamwork and good communication are of paramount importance.
Please click the link below to download the document.
Decisions relating to cardiopulmonary resuscitation (Adobe PDF format)
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