Reviewing the decision
The revised guidance clarifies that review of CPR decisions must be done on a clinically appropriate and individualised basis. A timeframe for review of the initial decision should reflect the variability of the patient's clinical situation. Patients, who are continuing to deteriorate with one or more irreversible conditions and with no prospect of recovery to a point where CPR might work, do not need to have the DNACPR decision reviewed.
Local clinical teams have a responsibility to ensure that CPR status is checked and clarified along with other aspects of anticipatory emergency care and treatment planning at every handover, safety huddle, ward round or multidisciplinary meeting.
When the lead clinician changes due to transfer or discharge, any DNACPR decision must be reviewed as soon as is reasonably possible, but it is assumed that the existing decision will remain valid meantime.
Where the team are notified of the appointment of a welfare guardian or welfare attorney after a DNACPR is in place, that person should be notified of the existence of the form, and consideration given to a review involving them.
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