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ST1&2 DNACPR - K ey I ssues & Approach

ST1&2 DNACPR - K ey I ssues & Approach. DNACPR – Key Issues. Consider The fundamentals The framework The decision making process The patient / family view Legal aspects. DNACPR – Fundamentals. The decision to offer CPR is a medical one Nothing to do with ‘ quality of life ’

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ST1&2 DNACPR - K ey I ssues & Approach

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  1. ST1&2DNACPR- Key Issues & Approach

  2. DNACPR – Key Issues • Consider • The fundamentals • The framework • The decision making process • The patient / family view • Legal aspects

  3. DNACPR – Fundamentals • The decision to offer CPR is a medical one • Nothing to do with ‘quality of life’ • If CPR is likely to be futile do not offer it

  4. DNA CPR – Framework • Is the patient at risk of a cardiopulmonary arrest? • Decision making • CPR is unlikely to be successful due to: • The likely outcome of successful CPR would not be of overall benefit to the patient • decided with patient • decided with legally appointed... • ...basis of overall benefit... • CPR is not in accord with a valid advance healthcare directive/decision (living will) which is applicable to the current circumstances

  5. DNA CPR – Decision making • Is CPR realistically likely to succeed? • What do we mean by ‘success’? • Population that we are considering • Facilities available • People available

  6. DNACPR – patient / family / legal issues • Patient / family view is only relevant if CPR is a treatment option • If success anticipated – discussion needed • If success not anticipated – inform patient • Relatives should not be asked to ‘decide’ unless patient lacks capacity & legally empowered to do so • Communicate sensitively!

  7. DNACPR – Approach • Consider • When you have done this • What worked well? • What didn’t?! • How to raise the subject • When to raise the subject • Practicalities

  8. DNACPR – Before any discussion • Your knowledge of • Illness trajectory & prognosis • Patient awareness & insight • Discussion • Benefit / burden • Timing

  9. CPR – Decision • What you think / what patient wants • You think possible / patient doesn’t want CPR • Simple • You think possible / patient wants CPR • Complicated • You think futile / patient doesn’t want CPR • Simple • You think futile / patient wants CPR • Complex

  10. Introducing the subject of DNACPR • Communication • Breaking bad news • Narrowing the information / knowledge gap • We know something we think they need to know! • How much do they actually know? • How much more, if any, do they want to know • When do they want to know • Who do they want to tell them

  11. The ‘bad’ news • What we feel we need to cover • Whether CPR should be offered or not • If ‘futile’ patient / loved ones need to know this • If ‘not futile’ then we need to know what patient wants

  12. Getting CPR raised • By patient and carer • Spontaneously • Prompted • Another professional e.g. the hospital said… • ‘My Thinking Ahead & Making Plans’

  13. Getting CPR raised • By us • Gauge patient understanding • Illness • Trajectory • Future

  14. Getting CPR raised • By us (continued) • Planning ahead (ACP!) • How do you feel you are doing? • Where would you like to be cared for? • And if things got worse…? • How do you see the future? • Are there any things you’d like to avoid? • Etc etc etc • What if there was a sudden change in your condition? • What if your heart was to stop? • Introduce CPR

  15. CPR – the subject matter • General • What it means • Life saving intervention v. Allow a natural death • Possible outcomes / uncertainties • Success / failure / quality of life • Whether ‘people’ would wish it • Individual • In your case… • ‘Fine line’ • Awareness raising, BUT • Clinical decision has already been made

  16. What DNACPR is not about • Anything other than CPR • Any other treatments e.g. antibiotics • Feeding • Fluids • Highlight everything else that we can still do

  17. Patient centred supportive care • What’s the most important thing in your life right now? • What helps you keep going? • How do you see the future? • What is your greatest worry or concern? • Are there ever times when you feel down? • If things get worse, where would you like to be cared for? Professor Scott Murray, University of Edinburgh

  18. DNA CPR – Practicalities • Completing the DNACPR form • Where should form be kept • When to update form • Patient transfer(!)

  19. DNA CPR – Practicalities • Communication • Patients home • Patient • Family / loved ones • OOH Services • Scottish Ambulance Service • Others?

  20. Thoughts / Comments / Questions?

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