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Resuscitation
&
Do Not Attempt Resuscitation Policy
Policy: C12
For use in Trust services where RiO has not yet gone live
Policy Descriptor
This Policy describes the procedure for ‘Resuscitation’ and
‘Do Not Attempt Resuscitation’ situations
Do you need this document in a different format?
Contact PALS – 0800 0730741 or email: dpn-tr.pals@nhs.net
1
C12 – Resuscitation Policy
Quick Read Summary
The Trust has an obligation to provide an effective and efficient
resuscitation service and to ensure that staff receive training and regular
updating appropriate to their role. The Trust also has an obligation to
ensure that an individual’s wishes are respected should they decide that
Introduction they do not want to be resuscitated.
All persons covered by the policy (adult, older people and children) will be
presumed to be for resuscitation in the event of a sudden collapse due to
cardio-pulmonary arrest unless a Do Not Attempt Resuscitation decision has
been made.
The purpose of the policy is to provide direction and guidance for
Purpose resuscitation and provide guidance for staff about those individuals to whom
the ‘Do Not Attempt Resuscitation’ applies.
This policy applies to all people using services, visitors and staff, should they
have a sudden cardio-pulmonary arrest, within the Trusts property. All
clinical staff with regular direct contact with people using services are
affected by this policy and have responsibilities under it.
The Resuscitation Committee is responsible for overseeing the provision of
resuscitation services in the Trust.
Directorate and Service Managers are responsible for the implementation of
the policy in their own areas
Duties & Ward/Team Managers are responsible for ensuring that;
Responsibilities Staff have training
They have the appropriate emergency equipment
They have a procedure /protocol for summoning the emergency
services.
An incident report form is completed
All staff hold responsibility to:
Attend training
Report concerns to their line manager
Initiate CPR in line with policy guidance.
Complete an incident report
All clinical staff should be able to recognise people in distress
Call for help / assistance
Resuscitation
Basic life support should be initiated
Procedures
Emergency services must be called
Defibrillation must only be used by trained staff
All people using services will be given cardio-pulmonary resuscitation (CPR)
Do Not Attempt
and/or defibrillation unless a clear entry has been documented in their care
Resuscitation
plan and the appropriate form contained in the appendix, or the person has
(DNAR)
recorded a wish not to be resuscitated through an advance decision.
Process for All events to which a cardiac arrest team is summoned must be audited
Monitoring (DoH HSC 2000/028)
Compliance with,
and the Compliance with the organisation-wide DNAR policy must be audited
Effectiveness of annually and reported to the Clinical Governance Lead.
this Policy
2
Document Control
Policy Ref No. C12
Version: Policy: V1.2 (revised September 2010, compliant
with people first language)
Replaces / dated: C12 Resuscitation Policy, June 2009
Author(s) Name / Job Title responsible / John Good, Nurse Consultant
e mail: john.good@nhs.net
EIA Date completed: 21/09/2009
Ratifying committee: Professions Group
Date ratified: 27 September 2010
Director / Sponsor Helen Smith, Joint Medical Director
Target audience / Staff Groups: All staff
Implementation date: June 2010
Review date: December 2011
Date Archived:
NHSLA Standards met: 1.4.8
Other Relevant Standards met:
3
Contents
Section Page
1 Introduction 5
2 Purpose 5
3 Duties & Responsibilities 5
4 Resuscitation Procedures 6
5 Procurement and Equipment 7
6 Training Requirements 8
7 Do Not Attempt Resuscitation (DNAR) 8
Process for Monitoring Compliance with, and the Effectiveness of this
8 11
Policy
9 Glossary/Definitions 11
10 References 12
Appendices
Appendix1 Resuscitation Committee membership and Terms of Reference 13
Appendix 2 Resuscitation Status Form 14
Appendix 3 Ward by ward arrangements 16
4
1. Introduction
1.1 The Trust has an obligation to provide an effective and efficient resuscitation service and to
ensure that staff receive training and regular updating appropriate to their role. The Trust
also has an obligation to ensure that an individual’s wishes are respected should they
decide that they do not want to be resuscitated.
1.2 This policy provides guidance for clinical practice and training for those with responsibilities
for resuscitation services within the Trust. This Resuscitation and Do Not Attempt
Resuscitation Policy follows the recommendations for clinical practice and training in
cardiopulmonary resuscitation published by the Resuscitation Council (UK) (RCUK) and the
British Medical Association (BMA) and also the RCUK and Royal College of Nursing (RCN)
statement on Decisions Relating to Cardiopulmonary Resuscitation. It has been written to
promote compliance with the National Health Service Litigation Authority (NHSLA) Risk
Management Standards (NHSLA, 2007), Health Circular 2000/028, the Human Rights Act
(1998), the Mental Capacity Act (2005) and the NPSA report RRR010 (2008).
2. Purpose
2.1 The purpose of the policy is to provide direction and guidance for the planning and
implementation of a high-quality and robust resuscitation service and provide guidance for
staff about those individuals to whom ‘Do Not Attempt Resuscitation’ decision applies.
3. Duties & Responsibilities
3.1 This policy applies to all people using services, visitors and staff, should they have a sudden
cardio-pulmonary arrest, within the Trusts property. All clinical staff with regular direct
contact with people using services are affected by this policy and have responsibilities under
it. In addition staff who may be expected to respond to a cardio-pulmonary arrest afflicting a
visitor or member of staff have responsibilities under it.
3.2 The Chief Executive has overall responsibility for ensuring that resources and mechanisms
are in place for the implementation, monitoring and review of this policy
3.3 The Resuscitation Committee is responsible for overseeing the provision of resuscitation
services in the Trust. Appendix 1 gives details of the composition of the committee.
3.4 Directorate and Service Managers are responsible for the implementation of the policy in
their own areas and should ensure that there are robust systems in place to monitor training
and incident recording and post incident support.
3.5 Ward/Team Managers are responsible for ensuring that;
They have a planned programme of training for staff
They have the appropriate emergency equipment for all their staff (eg pocket masks
for community staff) which is regularly checked and recorded.
They have a procedure /protocol for summoning the emergency services and Trust
emergency equipment if not available in their ward/area.
An incident report form is completed for every resuscitation attempt in line with the
incident reporting policy
All staff with direct contact with people using services and all designated first aiders hold
responsibility to:
Attend training and updates (yearly) in Basic Life Support (BLS)/Automatic External
defibrillation (AED) as directed by this policy and maintain professional standards. This
to include training on choking as directed by NPSA report (2008).
Report concerns to their line manager
5
Initiate CPR in line with policy guidance.
Complete an incident report for every resuscitation attempt in line with the incident
reporting policy.
4.0 Resuscitation Procedures
4.0.1The chances of survival following cardio-pulmonary arrest are usually poor; however the
rapid initiation of Basic Life Support and defibrillation can improve the outcome
considerably.
4.1 Response to a Sudden Cardiac Arrest
4.1.1 In all instances where a person is suspected of collapsing due to a cardio-pulmonary arrest
the ambulance service will be called. This does not apply to units which have a
resuscitation service (crash team) provided by an acute trust with whom they share the site.
4.1.2 Basic Life Support (BLS) with/without Automatic External Defibrillation (AED) should be
commenced and continue until the emergency services arrive, who will take responsibility for
the continuing health care needs and transportation of the person to the appropriate
Accident and Emergency Department.
NOTE - This will be the case unless a Do Not Attempt Resuscitation decision has been made
(see section 7 of this policy)
4.2 Initiation of Cardio-Pulmonary Resuscitation
4.2.1 All health and social care staff (managers, doctors, nurses, social workers,
psychologists/therapists, occupational therapists and support staff) that work directly with
people using Trust services are expected to recognise cardiac arrest, call for help and/or
initiate BLS. Staff who are trained to use the Trusts AED’s should initiate this procedure
upon arrival.
4.2.2. All support staff (e.g. Admin and Clerical) who work indirectly with people using Trust
services are expected to be able to recognise people in distress, call for help and assist staff
in such an emergency as required.
4.3 CPR on Trust Property
4.3.1 All persons covered by the policy (adult, older people and children) will be presumed to be
for resuscitation in the event of a sudden collapse due to cardio-pulmonary arrest. Each unit
must have available a suitable number of airway/barrier devices (e.g. pocket masks) to
assist in basic life support. All staff should know the whereabouts of these masks.
4.3.2 When someone is admitted to the Trust for inpatient treatment and care it will be the
responsibility of the persons treating medical officer (consultant psychiatrist) or nominated
deputy to undertake a physical examination. This should be repeated at other times if the
persons physical condition changes. This examination should determine the persons
physical health status, determining if there are any life threatening conditions which may
result in a cardio-pulmonary arrest. The ability to carry out a physical examination is subject
to their consent, see the Trusts policy on Consent to Treatment (C09)
4.3.3 All staff should be made aware of any person with a physical condition, which may result in
respiratory or cardiac arrest. The person must understand where possible the nature of their
condition and the resulting management plan to treat them in the event of an emergency.
4.3.4 In certain circumstances people may wish to exercise their right not to be resuscitated either
in person or through an advance decision, see the Trusts policy on Consent to Treatment
(C09). The persons wishes should always be respected.
6
4.3.5 In all instances where someone suffers a cardio-pulmonary arrest, a Trust incident form
must be completed and forwarded to the appropriate manager who will then decide if an
investigation is needed.
4.4 CPR in the Community
4.4.1 All people receiving community services will be presumed to be for resuscitation unless a
decision not to resuscitate has been agreed with the persons general practitioner (GP) prior
to a sudden collapse. All decisions with regard to a Do Not Attempt Resuscitation Order by
the GP should be documented. Failure to document such a decision places a legal
responsibility on the attending community staff to obtain emergency assistance.
4.5 Defibrillation
4.5.1 Defibrillators must only be operated by staff specifically trained in their use. The operation of
defibrillators by professionally registered staff is subject to them successfully completing the
Trusts BLS plus AED training and the ongoing requalification courses.
4.6 Cross Infection
4.6.1 Whilst the risk of infection transmission from the person receiving to the person giving BLS
during direct mouth-to-mouth resuscitation is extremely rare, isolated cases have been
reported. It is therefore advisable that direct mouth-to-mouth resuscitation (without a barrier
device) be avoided at all times. This is particularly important in the following circumstances:
All people who are known to have or are suspected of having an infectious disease;
All undiagnosed peoples entering the Accident & Emergency department, Outpatients or
other admission source.
Other persons where the medical history is unknown.
4.6.2 In situations where airway/barrier devices are not immediately available, staff should start
chest compressions whilst awaiting an airway/barrier device.
5. Procurement and equipment
5.1 All resuscitation equipment purchasing is subject to the organisations standardised strategy;
therefore, all resuscitation equipment purchased must be compliant with the
recommendations of the Resuscitation Committee.
5.2 The provision of suitable, standardised equipment is paramount in resuscitation attempts so
that staff are protected, proficient and comfortable with its use.
5.3 All areas where people using services are seen should have immediate access to
appropriate BLS equipment (e.g. mouth-to-mask devices).
5.4 All areas where people are seen where a cardiac arrest might be expected at least once
every five years should have access to Automated External Defibrillators (AEDs) within
three minutes.
5.4 In wards where restraint or rapid tranquilisation takes place the National Institute for Clinical
Excellence (NICE 2005) guidelines apply i.e. BLS with emergency equipment. Also see the
Trusts policy on Rapid Tranquilisation (C36). Please note that the use of emergency
resuscitation medication is not included in this. This follows a decision by the
medical director based on the possibility that our medical staff may lack the
competence/confidence in administering these.
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5.5 Should a team/area feel that the current equipment provision is not suitable a risk
assessment should be completed by the manager to indicate alternative and additional
equipment. Managers must then procure the required equipment using unit budgets as
necessary.
5.6 The location of emergency equipment should be clearly indicated using appropriate signage
and this area must be easily accessible to all staff.
6. Training Requirements
6.1 The committee / group / person responsible for the development of this policy will work with
staff from the Workforce Planning and Development service to identify how the
competences required by staff in various roles are developed and maintained. This should
ensure that the policy can be implemented safely and effectively to enable high quality
delivery of services.
6.2 The Workforce Planning and Development service will ensure that the processes identified
and fully described in the Learning and Development policy (reference HR50) section 15
are undertaken. These will include:
Identification of the competences required by the various types of staff affected by this
policy
Development of a competence framework for the levels of knowledge and skills
required to ensure effective implementation of the policy
Training needs analysis to identify the numbers of staff who will require the different
levels of competence
Identification of the ways in which these levels of competence may be acquired by staff
(including a range of learning methods)
Development of a business case, where required ,to identify options for delivery of
learning and the associated costs
Development of action plan(s) for the implementation of training
Systems to review the efficacy of the training
Systems to monitor that staff have undertaken the training
7. Do Not Attempt Resuscitation (DNAR) Guidelines
7.1 All people using services will be given cardio-pulmonary resuscitation (CPR) unless a clear
entry has been documented in the persons medical record, or the person has recorded a
wish not to be resuscitated through an advance decision, see the Trusts Policies on
Consent to Treatment (C09) and Mental Capacity Act 2005 (M07). Race, gender, age,
disability, sexuality or religion will not be factors when decisions about CPR are made.
Factors that do influence the decision about CPR are set out in the DNAR section (section
7) of this policy.
7.2 DNAR Decision Making
7.2.1 Where no explicit advance decision has been made about the appropriateness or otherwise
of attempting resuscitation on someone using services, and the express wishes of the
person are unknown and cannot be ascertained, there should be a presumption that health
professionals will make all reasonable efforts to attempt to revive the person.
7.2.2 Note should be taken of any DNAR decision recorded in the admission pack for Older
Peoples Mental Health Inpatient services or in the resuscitation status form (appendix 2).
7.2.3 In an emergency situation and in the absence of the persons consultant/GP, the staff on
duty should attempt CPR unless:
The person has refused CPR
8
The person is clearly in the terminal phase of illness; or
The burdens of treatment outweigh the benefit.
In OPMH Services the DPT Resuscitation status form is to be part of the admission
pack and sited in the persons notes immediately inside the front cover.
7.2.4 DNAR orders apply only to cardiopulmonary resuscitation. It should be made clear to the
person and those close to them and to the health care team that it does not imply “non-
treatment” and that all other treatment and care appropriate for the person will be
considered and offered.
7.3 When a DNAR decision is appropriate
7.3.1 Where Attempting CPR Will Not Restart the Persons Heart or Breathing
If the healthcare team is as certain as it can be that attempting CPR would not restart the
persons heart and breathing or the individual cannot gain any clinical benefit from an
attempt CPR will not be instigated. This decision must be arrived at via a consensus within
the team about the likely clinical outcome, and decision making must be based on clinical
assessment of the persons condition and up-to-date clinical guidelines.
7.3.2 Where there is No Benefit in Restarting the Persons Heart and Breathing
There is no benefit to be gained if only a very brief extension of life can be achieved and the
persons co-morbidity is such that imminent death cannot be averted. Similarly there is no
benefit to be gained by the person if he or she will never have awareness or the ability to
interact, and is therefore unable to experience benefit.
7.3.3 Where the Expected Benefit is outweighed by the Burdens
Where CPR may be successful in restarting the persons heart and breathing, and thus
prolong their life, the benefits to be gained from the prolongation of life must be weighed
against the burdens to the person of the treatment.
7.4 Responsibility for DNAR Decision Making
7.4.1 Overall responsibility for decisions about CPR and DNAR orders rests with the consultant or
GP in charge of the persons care. He / she should discuss the decision for an individual with
other health care professionals involved in a their care.
7.4.2 Any DNAR decision must be made on current clinical information. This information should
be reliable and up-to-date. A DNAR decision must be made on an individual basis. Standard
rules or blanket policies are unlawful and cannot apply.
7.4.3 In discussions with people close to the person, it should be made clear that their role is not
to make decisions on behalf of the person, but to act as an advocate for the their views and
preferences.
7.5 Incapacitated adults
7.5.1 All people should have their capacity to make a decision about resuscitation assessed and
this should be recorded on the resuscitation form. A FACE form should be completed if the
person does not have capacity as evidence of a ‘reasonable belief’ of incapacity to make the
resuscitation decision. The decision taken should then be in the persons best interest.
7.5.2 Assessment of capacity is as described in the Mental Capacity Act 2005 (Chapter 4 MCA
Code of Practice) and is a two stage test.
9
Stage 1. Does the person have an impairment of, or a disturbance in the functioning of
their mind or brain?
Stage 2. Does the impairment or disturbance mean that the person is unable to make a
specific decision they need to?
A person is unable to make a decision if they cannot:
1. Understand ‘relevant’ information about the decision
2. Retain that information in their mind
3. Use or weigh that information as part of the decision-making process
4. Communicate their decision
Attempts should be made to enhance capacity during the assessment wherever possible.
7.5.3 One of the key principles of the Mental Capacity Act 2005 is that any act done for, or any
decision made on behalf of a person who lacks capacity must be done, or made, in their
‘best interests’ Chapter 5 MCA 2005 Code of Practice. The exception is where an ‘advance
decision’ is in evidence –see above. The Act requires assessors to:
1. Encourage participation
2. Identify all relevant circumstances
3. Find out the persons views
4. Avoid discrimination
5. Assess whether the person might regain capacity
6. Not be motivated by a desire to bring about the persons death ie making assumptions
about the persons quality of life
7. Consult relevant others eg main carers, immediate relatives
8. Avoid restricting the persons rights ie act in the least restrictive way
9. Take all of the above into account
7.5.4 With regards to incapacitated adults, people close to the person should be kept informed
about their health and be involved in decision making in order to reflect the persons views
and preferences. It should be made clear that their role is not to take decisions on behalf of
the person. Relatives and others close to the person should be assured that their views on
what the person would want will be taken into account in decision making but they cannot
insist on treatment or non – treatment as the clinical staff are the decision makers in terms of
resuscitation.
7.6 Communicating DNAR Decisions
7.6.1 A sensitive discussion relating to DNAR decision making should be held at the earliest
opportunity with the competent person who is at foreseeable risk of cardiopulmonary arrest
or has a terminal illness. Information should not be forced on unwilling recipients and if
someone indicates that they do not wish to discuss resuscitation this wish should be
respected. Any discussion or information should take account of the persons communication
needs e.g. their first language or sensory impairment.
7.6.2 Where a DNAR decision has been made and there is no discussion with the person
because he or she has indicated a clear desire to avoid such a discussion, this must be
documented in the health records.
7.6.3 Where, after appropriate discussion, a person requests that no DNAR order is made, this
should be respected.
7.6.4 The persons known wishes and decisions relating to attempting CPR should be
communicated between health care professionals when they are referred to another service
or discharged.
10
7.6.5 If people are transferred from one Trust facility to another or to another Trust, existing DNAR
orders should be reviewed by the Consultant assuming responsibility for their care.
7.6.6 The DNAR decision needs to be clearly communicated to the ambulance personnel.
7.7 Recording DNAR Decisions
7.7.1 To avoid confusion the expression “Do not Attempt Cardiopulmonary Resuscitation”
should be used to note a DNAR decision in all health care records. This should be recorded
on the Resuscitation Status Form given in the appendix.
7.8. Reviewing the DNAR Decision
7.8.1 DNAR decisions must be reviewed regularly. The frequency of the review will be determined
by the health care professional in charge and may be influenced by:
Changes in the persons condition
Changes in the persons wishes
Transfer from one facility to another
Changes in the consultant in charge
8. Process for Monitoring Compliance with, and the Effectiveness of this Policy
8.1 All events to which a cardiac arrest team is summoned must be audited (DoH HSC
2000/028):
8.2 Compliance with the organisation-wide DNAR policy must be audited annually and reported
to the Clinical Governance Lead.
The Resuscitation Committee will:
Lead on the monitoring of all the minimum (Level 1) requirements within the current
NHSLA Risk Management Standards;
Feedback the review findings to the organisation-wide Clinical Governance Committee.
9. Glossary / Definitions
Cardiac Arrest is the sudden and complete loss of cardiac functions. This will be
evident by the absence of any signs of circulation.
Respiratory Arrest is the complete cessation of breathing, where a pulse is still present.
Cardio-Pulmonary Arrest is a combination of both of the above.
Cardio-Pulmonary Resuscitation (CPR) comprises of chest compressions and rescue
breathing. It may also involve defibrillation, airway management, including suction and
the use of oxygen.
Basic Life Support (BLS) comprises of the following elements; initial assessment,
summoning of the emergency services, airway maintenance, rescue breathing and chest
compressions to sustain life until the arrival of the emergency services. BLS implies that
no equipment apart from an airway/barrier device (e.g. pocket mask) is employed in this
procedure.
Basic Life Support with Emergency Equipment (BLS+EE) indicates the addition of
emergency equipment to the BLS procedure that is available in the area. This is a
standard that the Trust accepts as a minimum for its staff to achieve during resuscitation
attempts.
11
Automated External Defibrillator (AED) is the device used in addition to BLS+EE in an
attempt to reverse cardiac arrest. These devices are available on all inpatient units.
(NICE, 2005), see also the Trusts Rapid Tranquilisation Policy (P04).
DNAR – Do not attempt resuscitation.
10. References
Resuscitation Council (UK) (2001) Decisions Relating to Cardiopulmonary Resuscitation. A
Joint Statement from the British Medical Association, the Resuscitation Council (UK) and the
Royal College of Nursing. http://www.resus.org.uk/pages/dnar.htm [online]
NICE 2004 Short-term Management of Disturbed (Violent Behaviour in Psychiatric In-Patient
Settings). NICE Guideline, 2nd Draft
Resuscitation Council (UK) (2004), Cardiopulmonary Resuscitation, Standards for Clinical
Practice and Training. Resuscitation Council (UK)
NHS Litigation Authority (2007), Risk Management Resuscitation Document
Resuscitation Policy, Department of Health (2000), Health Service Circular 2000/028
National Institute for Clinical Excellence (2005), Violence. The short term management of
disturbed/violent behaviour in psychiatric in-patient settings and emergency departments.
Human Rights Act, (1998), HMSO
British Medical Association, Resuscitation Council (UK) and Royal College of Nursing,
(2001), Decisions relating to Cardiopulmonary Resuscitation
Mental Capacity Act 2005 Department of Health
Resuscitation Council (UK) (2005) Cardiopulmonary Resuscitation -
Standards for Clinical Practice and Training. A Joint Statement from the Royal College of
Anaesthetists, the Royal College of Physicians of London, the Intensive Care Society and the
Resuscitation Council (UK). London. Resuscitation Council (UK)
NPSA (2008) Rapid Response Report (010)
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Appendix 1
Resuscitation Committee Membership
Representatives from:
Medical staff
Nursing staff
Senior Management
Older adults services
Acute inpatient services
Learning and development
Others may be co-opted as required
Resuscitation Committee Terms of Reference
Include:
Overseeing the implementation of operational policies governing cardiopulmonary
resuscitation, practice and training.
Determine the level of training required by individual staff groups
Determine the amount and location of equipment required in individual areas
Ensure adherence to national guidelines and standards
Ensure suitable resuscitation equipment is evaluated and available
Ensure appropriate emergency drugs are available.
Ensure a suitable level of training is available in sufficient quantity
Formulate, maintain and update policies in resuscitation, ‘Do Not Attempt
Resuscitation’ and others deemed to be suitable for this committee
Audit of resuscitation events, equipment and DNAR order
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Appendix 2
Resuscitation Status Form
To be completed at (or before) first multi-disciplinary ward meeting following admission or transfer
Name of Person Receiving Services:………………………… Date of Birth:…………………………
In the event of sudden Cardiopulmonary Arrest the above person is …. (Please circle)
FOR attempted NOT for attempted
Cardiopulmonary Resuscitation Cardiopulmonary Resuscitation
If not for attempted Cardiopulmonary Resuscitation – please complete the following:
Date of Admission:…………………… Hospital No:………………… Ward:…………….
Address:……………………………………………………………………………………………….
………………………………………………………………………………………………………….
Diagnosis on Admission:……………………………………………………………………………..
!!Does the person have capacity? Yes No – If no complete capacity determination
overleaf
Date Details of decision and pertinent information Review Signature
Requirement
Names of people making decision. If relatives not
involved state why not.
NOTE: If resuscitation status changes during episode of care, cancel the ‘Decision not to
undertake Cardiopulmonary Resuscitation’ Form by crossing through diagonally stating
cancelled. The form should then be dated and signed.
NB. When people are transferred ensure that the ‘review requirement’ is valid for a further
48 hours
Name of Doctor Signing Form (PRINT)…………………………………………………………..
Doctor’s Signature……………………………………… Date:…………………………………..
(Please note this form should be signed regardless of option selected)
14
Determination of capacity (This is specific, not general determination. Note any documentation
referenced)
Is there an impairment of, or disturbance in, the Permanent Temporary
□ □ No □
functioning of the person’s mind or brain? impairment impairment
Person has ability to understand information related to the decision to be
Yes □ No □
made?
Person has ability to retain information related to the decision to be made? Yes □ No □
Person has ability to use or assess the information whilst considering the
Yes □ No □
decision?
Person has ability to communicate their decision by any means? Yes □ No □
Is the decision being made in their best interests and the assessor has;
1. Encouraged participation
2. Identified all relevant circumstances
3. Found out the persons views
4. Avoided discrimination
5. Assessed whether the person might regain capacity Yes □ No □
6. Not been motivated by a desire to bring about the persons death ie
making assumptions about the persons quality of life
7. Consulted relevant others eg main carers, immediate relatives
8. Avoided restricting the persons rights ie act in the least restrictive way
9. Taken all of the above into account?
Can the decision be delayed because the Not likely to Not
person is likely to regain capacity in the near Yes □ regain □ appropriate to □
future? capacity delay
15
Appendix 3
Ward by ward arrangements
Ward
KEY: Access to acute Emergency drugs not
Trust crash Team held – staff to initiate
OPMH Older people mental health
BLS
AMH Adult mental health
Immediate response
Dial 999 for cardiac
LD Learning Disabilities (Emergency Resus. arrest
drugs held for Crash
F Forensic Team use ONLY)
ND North Devon
Ex Exeter, East & Mid Devon
SD South Devon
Abbotsvale (OPMH ND) √
ASU Whipton (LD Ex) √
Avon (F Ex) √
Brunel ( OPMH SD)
Butler Clinic (F Ex) √
Chichester House (F Ex) √
Coombehaven (AMH Ex) √
David Barlow Unit (OPMH ND) √
Crash team bring
medication
Delderfield (AMH Ex) √
Haldon Unit (Eating dis Ex) √
Harbourne (OPMH SD)
Haytor (AMH SD) √
Resuscitation
medication held on
the unit
16
Oak Ward (AMH SD)
Resuscitation
medication held on
the unit
Ivycroft (LD SD)
Knightshayes (LD Ex) √
Leander Unit (F Ex) √
Melrose (OPMH Ex) √
Moorland View (AMH ND) √
Crash team bring
medication
Ocean View (AMH ND) √
Crash team bring
medication
Rougemont (OPMH Ex) √
Russell Clinic (Rehab Ex) √
St Johns Court (OPMH Ex) √
The Bungalow (OPMH Ex) √
Westleigh (OPMH Ex) √
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