CARDIOPULMONARY RESUSCITATION POLICY
Including the Framework for the use of Automated External Defibrillators (AEDs)
Decisions relating to Do Not Attempt Resuscitation (DNAR)
Subject: Policy for the provision of basic life support with or without
the use of an AED and guidance on decisions relating to DNAR
Date ratified: 23rd October 2007
Date Board Adopted: November 2007
Date implemented: December 2007
Date of review: October 2009
Person responsible for policy Resuscitation Training Officer
Implementation and review:
Policy location: Clinical Policies Folder/ PCT Extranet
The function of basic life support (BLS) is to maintain perfusion and oxygenation of
the vital organs, to a certain extent, and buy some very valuable time prior to the
arrival of a defibrillator. It has been identified that BLS can double the chances of
survival in the event a that defibrillator is not immediately available 1. Both early
BLS and early defibrillation are fundamental parts of the chain of survival, failure of
either of which will contribute significantly to the reduced chances of the patient
The adult and paediatric BLS algorhythms have been updated to reflect changes in
the Resuscitation Council UK guidelines 3. It will take time for this change in practice
to be disseminated to all staff and as this transition is made, there will invariably be
some variation in practice between individuals and departments. The update
guidelines do not define the only way in which resuscitation should be achieved,
they merely represent a widely accepted view of how resuscitation can be
undertaken both safely and effectively.
This policy sets out the organisation, management and provision of an effective
resuscitation policy within Sandwell PCT, incorporating guidelines for the
resuscitation or non-resuscitation of adults and children with or without the use of
2.1 To ensure staff have the skills and knowledge to perform cardiopulmonary
resuscitation on any person who has suffered a cardiac or respiratory arrest, with or
without the use of an AED.
2.2 To ensure staff understand the process if a healthcare team has taken the prior
decision, in conjunction with the patient and their carer(s), that such a course of
action should not be pursed (DNAR) or where the attempt is deemed to be futile.
3.1 To enable staff to perform basic life support, based on current Resuscitation
Council UK guidelines, to appropriate persons who are unresponsive and not
3.2 To enable appropriately trained staff to safely use an AED until additional medical
3.3 To outline the minimum standards and requirements with regards to training for all
PCT employees, including independent contractors, with direct patient contact.
Training will be appropriate to each individual’s abilities and roles.
3.4 To describe the issues involved and show an understanding of the decisions
relating to ‘Do Not Attempt Resuscitation’ including advance decisions and advance
Advance Decision Established legal right for a competent, informed adult to refuse
medical treatment in advance of them losing mental capacity
should particular circumstances occur. This is legally binding on
Advance Statement Advance statement by a competent individual on how they would
wish to be treated if they suffer loss of mental capacity in
particular circumstances taken with the full understanding of the
implications of their choices. This is not legally binding on the
AED Automated External Defibrillator. Medical device that
automatically interprets ECG and defibrillates the patient where
ALS Advanced Life Support
BLS Basic Life Support
Cardiac Arrest Sudden and complete loss of cardiac output
Cardiopulmonary Artificial ventilations and chest compressions to maintain
Resuscitation perfusion of the vital organs
Clinical Staff Any medical, nursing, dental, pharmaceutical healthcare
professional or allied health care professional involved in patient
Defibrillation The restoration of a non-shockable perfusing rhythm of the heart
that is either in ventricular fibrillation or pulseless ventricular
tachycardia, by applying an external high voltage electric current.
EMRT Emergency Medical Response Team
ILS Immediate Life Support. The sequence of events involved in
resuscitation that includes advanced airway management, BLS,
advisory defibrillation and patient assessment.
Mental Capacity An ability to understand the implications of a particular decision
which the individual purports to make.
Qualified and Non- Healthcare assistants, nursing auxiliaries, nursery nurses,
Qualified Support and clerical and secretarial staff and link workers.
RCUK Resuscitation Council UK
RTO Resuscitation Training Officer. Facilitator for the co-ordination of
training for the PCT as well as the provision of additional
resuscitation services such as audit, equipment checks, advisor
on resuscitation issues to the PCT, support to staff, post event
Pulseless VT Pulseless Ventricular Tachycardia. A broad complex tachycardia
originating in the ventricles, and the patient showing signs and
symptoms of a cardiac arrest
VF Ventricular Fibrillation. Rapid and chaotic ventricular activity with
no mechanical effect.
5.0 Roles And Responsibilities
5.1 All PCT Clinical Staff
PCT clinical staff are responsible for ensuring that they attend and participate in
mandatory resuscitation training on an annual basis, as a minimum. Individuals
are expected to perform CPR on another individual to the best of their ability,
physical capability and with minimal risk to the rescuer’s health and safety. It is
ultimately the individual’s responsibility to ensure they have the skills necessary
to carry out their duties and, where skill decay has been identified, the individual
should rectify this matter as soon as possible.
All PCT clinical staff must be trained as a minimum in adult basic life support, no
longer than 6 months from commencing employment.
Where any member of staff involved in a resuscitation attempt whilst on duty, a
PCT clinical incident form must be completed and returned to the line manager
by the end of the shift. Staff should follow the PCT procedure for reporting
In the event an AED has been used, an RCUK Event Report Form should be
completed by the most senior member of staff in attendance at the event.
Replacement forms are available from the Resuscitation Training Officer.
In all incidents, the PCT Resuscitation Training Officer should be informed.
5.2 Line Managers
Identify those individuals who make up the clinical healthcare team and ensure
they receive appropriate training.
Ensure all designated staff attend resuscitation training as laid down by this
Ensure that resuscitation training is included in all induction programmes.
Ensure that the PCT Resuscitation Training Officer is informed of all clinical
incidents that occur.
5.3 PCT Resuscitation Training Officer
Ensure resuscitation training is delivered according to current RCUK guidelines
Ensure clinical areas are advised of changes to recommended equipment levels/
Ensure clinical areas are advised of changes to recommended treatment
Ensure all reported resuscitation attempts are evaluated against current RCUK
guidelines and remedial training is provided as required.
Ensure resuscitation policies are reviewed and updated upon each change in
recommended management guidelines or every 2 years, in line with PCT policy.
Debrief and support those members of staff involved in a resuscitation attempt
Annual audit of equipment
5.4 PCT Board
Ensure funding is available for
i. Systematic upgrading of resuscitation equipment according to clinical
guidelines, where appropriate
ii. Training equipment to meet current standards and anticipated needs
iii. Continuing professional education of relevant clinical staff in resuscitation
and emergency care procedures
Ensure resuscitation policies are in operation and reviewed
6.1 Equipment for BLS, including defibrillators, will be standardised wherever possible
throughout the PCT. Recommended lists of equipment maybe obtained from the
6.2 As a minimum, personal protective equipment, such as gloves and pocket masks
or face shields should be made available to all PCT staff who work on PCT
healthcare premises and to those that are community based.
6.3 Resuscitation equipment must be checked regularly and recorded, on a weekly
basis by a designated, named individual, designated by the site.
6.4 Any equipment found to be missing, out of date or faulty must be reported to the
Line Manager and replaced immediately via the appropriate mechanism.
6.5 PCT staff are only expected to use the equipment appropriate to their training and
6.6 Where an AED has been used in a resuscitation attempt, the electronic data needs
to be retrieved using the facilities/ software relevant to the AED in question. This
can be accessed by contacting the Resuscitation Training Officer.
6.7 Oxygen is a prescription only drug and has a vital role in the management of any
resuscitation attempt. It can be delivered via a pocket mask or bag valve mask (Ambu bag)
for those that have access to them and are able to effectively use them. Only in the event
of a resuscitation attempt can oxygen be administered to all patients at high flow, including
COPD patients, by members of staff who have been trained in the use of oxygen.
7.0 Decontamination, Calibration and Maintenance of Equipment
In the event a pocket mask has been utilised, PCT staff can acquire a replacement
mask from the Resuscitation Officer. Non-PCT employed staff may choose to
replace a used pocket mask or clean it as recommended by the manufacturer.
Please note the one way valve and filter is single patient use only and will need to
be discarded and replaced.
Modern AEDs have a comprehensive self test system that carries out diagnostic
and safety checks on a daily, weekly and monthly basis. If any of these checks
reveals a fault, the AED will alert the user by means of a visual and/ or audible
warning. It is the responsibility of the user to be familiar with these warnings as
detailed in the manufacturer’s manual.
The user will need to check on a weekly basis, unless otherwise stated:
Status of the AED
AED unit is intact and undamaged
Disposable battery is not due for replacement
Ensure AED is not due for service
RCUK Event Report Form is available
Check sheet is filled in for auditable purposes
It is the responsibility of each site where an AED is located, to arrange for annual
service, in accordance with the manufacturer’s instructions.
8.0 Action In The Event Of A Cardiac Arrest
8.1 Following the sudden collapse of an individual, staff should:
Call for medical assistance depending on location
For those working in a hospital environment, call the EMRT by dialling
For any other location, call for an emergency ambulance by dialling
999 or 112 (112 is the standard European emergency number). Refer
to CLIN 061 999 Guidelines for Community Nurses 7.
8.2 In some areas, it may be necessary to dial 9 or 0, depending on site, for an outside
line, therefore the emergency service number is 9999 (or 0999).
8.3 In all cases, the exact location and nature of event should be stated.
NB/ In the event that the rescuer is on their own and needs to leave the patient to seek
medical assistance, they should do so as soon as they have assessed that the patient is
unconscious and either not breathing or breathing abnormally. If the patient is an infant or
child, 1 minute BLS should be commenced prior to seeking help.
8.4 In the case of the unconscious, abnormal breathing patient, the current RCUK
guidelines 2005 should be followed once update training has been received. Until
this time, individuals should continue to use the old guidelines from their last update
until they have been refreshed (Appendices 1 and 2).
8.5 Those staff that work at City Hospital, Sandwell General Hospital and/ or Rowley
Regis Hospital should be familiar with the Resuscitation Policy from SWBH 8.
9.0 Handover And Reporting Procedures
9.1 On arrival of ALS personnel i.e. EMRT/ paramedics, the patient will be transferred
to their care.
9.2 Information that may be of importance to hand over will include:
Patient details inc. medical conditions, medication, allergies etc.
History of current event
Change in patients condition
Next of kin if known
9.3 Complete a PCT Clinical Incident Report form and follow the Clinical Incident
9.4 Complete a RCUK Event Report form if an AED has been utilized
9.5 Report the incident to Line Manager
9.6 Report the incident to the Resuscitation Training Officer
9.7 Following the use of an AED, it is the responsibility of the operator or other
authorized person on duty at the time, to prepare the machine for a state of readiness in
accordance with the manufacturer’s instructions.
9.8 A period of time allowing for ‘reflective practice’ or ‘debriefing’ should be made
available after any resuscitation attempt.
10.1 Performance at an incident is often reflected by the degree and amount of training
received. Staff will be expected to undertake training appropriate to their roles.
10.2 All PCT employed clinical staff must attend adult BLS training on an annual basis.
10.3 All PCT employed clinical staff who have contact with babies and children as part
of their job role must attend combined adult and paediatric BLS training on an annual
10.4 All independent contractors should ensure that resuscitation training occurs at
least every 18 months for clinical staff and 3 years for non-clinical staff. It is ultimately the
responsibility of the contractors to ensure that all staff have fulfilled all minimum training
criteria. Agency and locum staff are not generally included in the Trust resuscitation
training program although those working in the organization on a long term basis (3
months or longer) maybe included in the program.
10.5 Records of those who have attended training will be held by the Learning and
Development Department/ line manager.
11.0 Framework For The Deployment Of Automated External Defibrillators Within
11.1 The RCUK sets the standards and guidelines with regards to treatment algorhythms
and training in the use of AEDs. Their importance is highlighted by the following
“Electrical defibrillation is well established as the only effective therapy for cardiac
arrest caused by VF or pulseless VT. The scientific evidence to support early
defibrillation is overwhelming; the delay from collapse to the delivery of the first shock
is the single most important determinant of survival. The chances of successful
defibrillation decline at a rate of 7-10% with each minute of delay; basic life support
will help to maintain a shockable rhythm but is not a definitive treatment.” 2
11.2 In the interest of improving standards of medical care to patients, an AED has been
placed in a number of health assessment centres and leisure facilities. This list will be
updated on an annual basis by the Resuscitation Officer.
12.0 Training And Authorisation Requirements
12.1 All training will be carried out in accordance with, and conform to, the RCUK
published recommendations and will be structured as follows:
Clinical staff with AED on work premises - Basic Life Support and
AED training valid for one year, as a minimum, with the option to
attend the Immediate Life Support course (arranged by the
Resuscitation Training Officer)
Non-clinical staff with an AED on work premises – Basic Life Support
and AED training valid for one year only (arranged by the
Resuscitation Training Officer)
12.2 The ILS course will only be offered to those clinical staff with access to an AED
12.3 All staff trained to use a defibrillator must familiarize themselves with the contents of
the operation and service manual supplied with each defibrillator.
12.4 Only those individuals who hold a current, valid certificate for the training in the safe
use of an AED can use an AED in any situation. It is the responsibility of the individual
to seek refresher training before their certificate expires.
12.5 Records of those who have attended training will be held by the Learning and
13.0 Use of AEDs on Children
When resuscitating children, oxygen delivery rather than defibrillation is the critical step as
ventricular fibrillation is rare 14.
Standard AEDs are suitable for use in children above 8 years. In children between 1-8
years, paediatric pads or a paediatric mode should be used on an AED if available. If
these facilities are not available, the AED should be used as it is. There is insufficient
evidence to support a recommendation for or against the use of AEDs in children less than
1 year 3.
14.0 Routine Maintenance And Checks
Refer to point 7.0
15.0 Handover and Reporting Procedures
Refer to point 8.0
16.0 Decisions Not To Attempt Cardiopulmonary Resuscitation (DNAR) including
Cardiopulmonary resuscitation can technically be attempted on any individual whose
cardiac and respiratory function fails. However, there will eventually come a time where
cardiac arrest is a natural terminal event as opposed to a medical emergency, in which
case, the process of carrying out CPR would be inappropriate. It is important to be able to
identify these patients, as well as those patients who do not wish CPR to be attempted on
themselves and competently refuse (advance decision). This policy is based on a joint
statement from the British Medical Association, The Resuscitation Council (UK) and the
Royal College of Nursing 9, 11.
In the event that there has been no explicit advance decision made by the appropriate
medical staff or by the patient as in the case of an advance decision, or the expressed
wishes of the patient are not known and cannot be ascertained, there should be a
presumption that reasonable efforts will be made to resuscitate the patient. A patient’s
age, race, gender or religion is not a factor when deciding about resuscitation.
17.0 Conditions In Which A DNAR Is Applicable
Each patient must be assessed on an individual basis and decisions should be made
depending on individual circumstances. A DNAR decision should be made only after
appropriate consultation and consideration of all relevant aspects of the patient’s condition
have been taken into account. Overall responsibility for DNAR related decisions rests with
the GP or consultant in charge of the patient’s care. The views of the patient and people
close to the patient (where appropriate) as well as other members of the healthcare team
must be acknowledged.
A DNAR decision maybe based on the following:
17.1 Where attempting CPR will not restart the patient’s heart and breathing
There is no clinical benefit from attempting to resuscitate a patient whom the clinical team
view is unable to support breathing and circulation by themselves. This decision will arrive
based on clinical assessment and current guidelines. The aim is to have a general
consensus of opinion.
17.2 Where there is no benefit restarting the patient’s heart and breathing
No benefit is gained if only a brief extension of life can be achieved and the
patient’s co-morbidity is such that imminent death cannot be averted. Also, no
benefit is gained by the patient if they will never have awareness or the ability to
interact and is consequently unable to experience benefit.
17.3 Where the expected benefit is outweighed by the burdens
Where CPR maybe successful in restarting the patient’s heart and breathing, and
thus prolong the patient’s life, the benefits to be gained from the prolongation of life
must be weighed against the burdens to the patient of the treatment.
The duty to protect life must be balanced with the obligation not to subject the
patient to inhuman or degrading treatment 10
In practice, the application of a DNAR will only be relevant in specific situations, such as
patient’s under constant supervision, residing in residential/ nursing home/ hospice
accommodation or who are receiving intensive nursing care at home.
17.4 Refusal of Treatment including Advance Decisions
There should be no attempted resuscitation on a patient if it is contrary to the recorded,
sustained wishes of the mentally competent adult who is aware of the implications at the
time of making that advance decision. Such a patient’s informed and competently made
refusal is legally binding.
The Mental Capacity Act 2005 12 has introduced a number of rules individuals must follow
when making an advance decision, summarized below:
- It must be valid. The person must not have withdrawn it, or overridden it by
making a Legal Power of Attorney that relates to the treatment in the advance decision, or
acted in a way that is clearly inconsistent with the advance decision.
- It must be applicable to the treatment in question. It should clearly refer to the
treatment in question and explain which circumstances which the refusal refers to. If there
have been changes in circumstances which there are reasonable grounds for believing
would have affected a person’s advance decision when they made it, then it may not be
Additional regulations have been set out for advance decisions that refuse life sustaining
treatment, thus the following requirements are requested to be fulfilled;
- It must be in writing.
- It must be signed by the individual in the presence of a witness who must also sign
the document. It can also be signed on the individual’s behalf at their direction if they are
unable to sign it for themselves.
- It must be verified by a specific statement made by the individual that says that the
advance decision is to apply to the specified treatment even if life is at risk.
Liability will not be incurred for providing treatment in the patient’s best interests if, having
taken reasonable steps, you do not know or are not satisfied that a valid and applicable
advance decision exists. If there is reasonable evidence to suggest there is a valid and
applicable advance decision then liability will not be incurred for the consequences of
abiding by it and not providing treatment.
18.0 Decision Making
18.1 Overall Responsibility
Overall responsibility of all CPR related decisions lies with the consultant or GP in
charge of the patient’s care. The views of the medical/ nursing team and relatives
are all taken in to account when discussing the sensitive issues related to end of life
decisions. It is imperative that all decisions are communicated to all the relevant staff
in order to prevent any confusion or conflict of information and therefore treatment.
Any discussions about whether to attempt CPR, and any anticipatory decisions,
should be documented, signed and dated in the patient’s records.
18.2 Competent Adults
Individuals have the legal and ethical right to be involved in decisions relating to
them and thus such discussions should be carried out sensitively with competent
patients, if they are willing to do so. Where a DNAR order has been made and the
patient has not been involved as they have clearly stated they do not want to be
involved in discussions, this must be documented in the medical records and notes,
with the reason being given.
Also, refusal by a competent patient for information to be shared with close family or
friends should also be respected (appendix 4).
18.3 Incapacitated Adults
No person is legally entitled to give consent to medical treatment on behalf of an
adult who lacks decision making capacity. Clinicians have authority to act in their
patients’ best interests where consent is otherwise unobtainable. Those people
close to the patient must be informed of all decisions made regarding the patient
and their views be taken into account, but ultimately they cannot insist on treatment
or non-treatment unless they are acting as a personal welfare legal power of
attorney and have been given written permission regarding life sustaining treatment
18.4 Children And Young People
The views of children and young people must be taken into account in decisions
relating to their treatment, including CPR. Competent young people are entitled to
give consent to medical treatment, and where they lack competence, it is generally
their parents who make decisions on their behalf. Refusal of treatment by
competent young people is not necessarily binding upon doctors since the courts
have ruled that consent from people with parental responsibility, or the court, still
allows doctors to provide treatment. If disagreement persists regarding end of life
decisions, legal advice should be sought. Parents cannot require doctors to provide
treatment contrary to their professional judgment, but should try to accommodate
parents’ wishes as far is compatible with protecting the child’s interests. Further
advice relating to children and younger people should be sought from the PCT
Medical Director or other appropriate expert.
18.5 Palliative Care Patients
Consideration should be given to end of life decisions early on in the involvement of
the clinical team. In the absence of such a decision having been made or the
instructions of a valid and applicable advance decision, in the event that the
individual suffers a cardiac arrest, the patient is by definition incompetent to make a
decision regarding CPR and thus it is the attendant’s legal responsibility to act in
the patient’s best interest.
NB/. If English is not the first language of a patient, discussions regarding their treatment
must be undertaken using an impartial qualified interpreter through SILCS. If this is the
case, their name and designation should be clearly documented.
Ideally, a general consensus of opinion is the aim of the exercise. If there is
disagreement, this needs to be documented in the patient’s notes. Where the
clinical decision is seriously challenged and agreement cannot be reached, some
form of legal review maybe necessary and legal advice should be sought.
19.0 Communication and Recording of Decisions
19.1 Any decision relating to CPR must be readily accessible to all the healthcare
professionals who maybe involved with the patient’s care. PCT managers should ensure
that effective communication systems are in place for use between healthcare
professionals delivering patient care. When a patient is referred to, or discharged from one
place of care to another, then any decisions as well as the wishes of the patient should be
communicated to the receiving healthcare professionals/carers. The usual rules of
confidentiality should be adhered to.
19.2 Any advance DNAR decision must be reviewed regularly, especially if the patient’s
condition changes. The frequency of review is dependant of the individuals condition
but on each occasion, the following must be documented:
i. reason for the decision
ii. date of decision
iii. date for review
iv. details of review
v. with whom the decision has been discussed
vi. name, title and signature of individual who has authorized DNAR decision
vii. details of any disagreement
Decisions not to attempt resuscitation (DNAR) including advance decision making will be
discussed in all basic life support training sessions. Specific sessions dealing with this
topic maybe arranged via the PCT Resuscitation Training Officer.
21. 0 Auditable Standards
Audit will enable any problem areas to be addressed and will also encourage best
practice. The process and outcome of all resuscitation attempts will be audited via the
Clinical Incident Reporting system. Areas for analysis will include availability and
performance of individuals involved, standard and reliability of equipment available and
any short comings with regards to training, equipment or procedures implemented in any
The process should also include feedback and discussion with all individuals involved.
The data in any AED used in a resuscitation attempt will be downloaded and used for
audit. A carbon copy of the Resuscitation Council UK Event Report form will be sent to the
Resuscitation Council for audit.
The numbers of staff attending mandatory training will be collated by the Learning and
Development department and will be available for audit.
The funding for the placement of AEDs in the healthcare assessment centres have been
incorporated into their service level agreements.
The funding for the placement of the AEDs in the sites for Leisure Services is joint funded
by Leisure Services and PCT pre-existing budget.
1 Handley Anthony J, Koster Rudolph, Monsieurs Koen, Perkins GD, Davies S,
Bossaert L. European Resuscitation Council Guidelines for Resuscitation 2005
Section 2. Adult basic life support and use of automated external defibrillators.
Resuscitation (2005) 67S1, S7-S23
2. Nolan J. European Resuscitation Council Guidelines for Resuscitation 2005 Section
1. Introduction. Resuscitation (2005) 67S1, S3-S6
3. Resuscitation Guidelines (2005) Resuscitation Council (UK)
4. Resuscitation Council (2001) Cardiopulmonary resuscitation for clinical practice and
training in Primary Care Resuscitation Council (UK).
5. Colquhoun M and Jevon P. (2000) Resuscitation in Primary Care Oxford
6. PCT CLIN/ 085 Prescribing Policy for Medical and Non-Medical Prescribers
7. PCT CLIN/061 999 Guidelines for Community Nurses
8. SWBH/CLIN/011 Resuscitation Policy
9. British Medical Association, Royal College of Nursing, Resuscitation Council UK
(2002) Decisions relating to cardiopulmonary resuscitation: A joint statement from
the British Medical Association, the Resuscitation Council UK and the Royal
College of Nursing, 2002.
10. British Medical Association. The impact of the Human Rights Act 1998 on medical
decision making. October 2000.
11. For further guidance see British Medical Association. Advance statements about
medical treatment. BMA 1995.
12. Mental Capacity Act 2005
13. Advanced Life Support Group. Pre-hospital Paediatric Life Support. BMJ 1999
ADULT BASIC LIFE SUPPORT
Shout for help
NOT BREATHING NORMALLY?
2 rescue breaths
PAEDIATRIC BASIC LIFE SUPPORT
Shout for help
NOT BREATHING NORMALLY?
5 rescue breaths
2 rescue breaths
If alone, perform CPR for 1 minute BEFORE going for help
AED Universal Algorhythm
Call for help
Not breathing normally
Send or go for AED
Until AED is attached
SHOCK NO SHOCK
150-360 J biphasic
0r 360 J monophasic
Immediately resume Immediately resume
CPR 30:2 CPR 30:2
for 2 mins for 2 mins
Continue until the
victim starts to
Decisions Relating To Cardiopulmonary Resuscitation
Ensure patient has access to
information about decision making in
relation to CPR
Senior health professional should
initiate sensitive discussion with patient
Respect patient’s wishes not to
Assess Clinical Issues
Is CPR likely to restart the patient’s heart and breathing?
Would restarting the patient’s heart and breathing provide
Do the expected benefits outweigh the potential burdens
Responsibility for the decision rests with the
consultant or GP in charge of care. If there is a serious disagreement between the
family and health team, legal advice should be sought.
Communicate The Decision
Ensure effective communication of decision
to relevant health professionals
Decisions Relating To Cardiopulmonary Resuscitation
Is there a valid and applicable advance refusal of CPR?
(including a personal welfare legal power of attorney
with written permission regarding specific life
Assess the best interests of the patient
What is known about the patient’s
wishes regarding resuscitation? Communicate the decision
Did the patient request confidentiality? Record the patient’s
Did the patient identify people to be wishes clearly in notes
consulted about treatment? and communicate
Seek the views of people close to the decision to relevant
patient about what he or she would health professionals
Discuss with the clinical team
Assess Clinical Issues
Is CPR likely to restart the patient’s
heart and breathing?
Would restarting the patient’s heart and
breathing provide any benefit?
Do the expected benefits outweigh the
potential burdens of treatment?
Responsibility for the decision rests with
the consultant or GP in charge of care.
If there is a serious disagreement
between the family and health team,
legal advice should be sought.
Communicate The Decision
Ensure effective communication of
decision to relevant health professionals