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Do not attempt resuscitation decisions (DNACPR): Do we fulfil the human rights act?

Marianne Tinkler, Katherine Millington
European Respiratory Journal 2016 48: PA3741; DOI: 10.1183/13993003.congress-2016.PA3741
Marianne Tinkler
1Respiratory Department, North Bristol NHS Trust, Bristol, United Kingdom
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Katherine Millington
1Respiratory Department, North Bristol NHS Trust, Bristol, United Kingdom
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Abstract

Background: t Recent Court of Appeals rulings found failure to discuss DNACPR decision breached Article 8 of the European Human Rights Act. Patients and families should be involved in decision making process. (Tracey 2014). These decisions should be communicated to primary care.

Aims: To assess practice of discussions of DNACPR decisions with patients & family; consultant review of decisions & communication with primary care.

Method: Retrospective review of COPD admission notes in North Bristol Trust between 1st February – 30th April 2014 (N=91). Existing community DNACPR were excluded (N=2)

Results: 23.5% had hospital DNACPR forms completed. There were 4 deaths. 86% were completed by a junior doctor. Consultants reviewed 83% of decisions, 61% <24 hours. 71.4% patients were involved in decisions. 4% had no reason why not discussed.

Reason for DNACPRDetails
Resuscitation would not be successful n=129 (75%) discussed 3 (25%) NOT discussed Reasons for not discussing: • “confused from respiratory failure” (n= 1) • “Patient very unwell” (n=1) • no reason stated (n=1)
May be successful but followed by unacceptable quality of life n=31 (33%) discussed. 2 (33%) NOT discussed Reasons for not discussing • “patient too unwell” (n=2)
Wishes of patient n=66 (100%) discussed

100% not discussed with patient were discussed with family. No DNACPR decision was recorded on discharge summary.

Discussion: There was good compliance with legal duty to discuss with patient. The majority not discussed were due to patient being too unwell.

There is a disparity, however, when communicating with primary care, with none communicated on discharge summary. Discharge summary template has been adjusted to improve this.

  • COPD - management
  • Chronic disease
  • End of life
  • Copyright ©the authors 2016
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Do not attempt resuscitation decisions (DNACPR): Do we fulfil the human rights act?
Marianne Tinkler, Katherine Millington
European Respiratory Journal Sep 2016, 48 (suppl 60) PA3741; DOI: 10.1183/13993003.congress-2016.PA3741

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Do not attempt resuscitation decisions (DNACPR): Do we fulfil the human rights act?
Marianne Tinkler, Katherine Millington
European Respiratory Journal Sep 2016, 48 (suppl 60) PA3741; DOI: 10.1183/13993003.congress-2016.PA3741
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