! This document was superseded by Decisions relating to Cardiopulmonary Resuscitation (3rd edition)
A Joint Statement from the British Medical Association, the Resuscitation Council (UK), and the Royal College of Nursing
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 Erroneous reporting led to some concerns that doctors' opinions could be superseded, patients insufficiently consulted or that inexperienced nurses might make such decisions.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 patient’s 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.
Decisions relating to CPR
October 2007, updated November 2007