Do not attempt resuscitation (DNAR) form

Last reviewed 03/2021

Do not attempt resuscitation (DNAR) form

It is recommended that the DNAR order should travel with the patient whenever possible and appropriate and should be recognised and accepted by all healthcare services. If healthcare organisations require copies of the DNAR order for audit or records purposes it is recommended that each form is available in duplicate or triplicate with non-carbon copies that are a different colour and that have different printed wording to reflect their purpose, so that only the original (top) copy can be identified as a DNAR order.

Guidance for filling in the DNAR forms:

• This form should be completed legibly in black ball point ink
  • All sections should be completed
    
    
    • the patient's full name, date of birth and address should be written clearly
      
      
    • the date of writing the order should be entered
      
      
    • this order will be regarded as "INDEFINITE" unless it is clearly cancelled or a definite review date is specified
      
      
    • the order should be reviewed whenever clinically appropriate or whenever the patient is transferred from one healthcare institution to another, admitted from home or discharged home
      
      
    • if the decision is cancelled the form should be crossed through with 2 diagonal lines in black ball-point ink and "CANCELLED" written clearly between them, signed and dated by the healthcare professional cancelling the order
      
      
      
      
• 1. Capacity/advance decisions
  • record the assessment of capacity in the clinical notes. Ensure that any advance decision is valid for the patient's current circumstances
  • 16 and 17-year-olds:
    • whilst 16 and 17-year-olds with capacity are treated as adults for the purposes of consent, parental responsibility will continue until they reach age 18. Legal advice should be sought in the event of disagreements on this issue between a young person of 16 or 17 and those holding parental responsibility
      
      
• 2. Summary of the main clinical problems and reasons why CPR would be inappropriate, unsuccessful or not in the patient's best interests
  • be as specific as possible
    
    
• 3. Summary of communication with patient...
  • state clearly what was discussed and agreed. If this decision was not discussed with the patient state the reason why this was inappropriate. It is not essential to discuss CPR with every patient. If a patient is in the final stages of a terminal illness and discussion would cause distress without any likelihood of benefit this situation should be recorded
    
    
• 4. Summary of communication with patient's relatives or friends
  • If the patient does not have capacity their relatives or friends must be consulted and may be able to help by indicating what the patient would decide if able to do so. If the patient has made a Lasting Power of Attorney, appointing a Welfare Attorney to make decisions on their behalf, that person must be consulted. A Welfare Attorney may be able to refuse life-sustaining treatment on behalf of the patient if this power is included in the original Lasting Power of Attorney
  • If the patient has capacity ensure that discussion with others does not breach confidentiality
  • State the names and relationships of relatives or friends or other representatives with whom this decision has been discussed. More detailed description of such discussion should be recorded in the clinical notes where appropriate
    
    
• 5. Members of multidisciplinary team...
  • State names and positions. Ensure that the DNAR order has been communicated to all relevant members of the healthcare team
    
    
• 6. Healthcare professional completing this DNAR order
  • will vary according to circumstances and local arrangements. In general this should be the most senior healthcare professional immediately available
    
    
• 7. Review / endorsement...
  • decision must be endorsed by the most senior healthcare professional responsible for the patient's care at the earliest opportunity. Further endorsement should be signed whenever the decision is reviewed. A fixed review date is not recommended. Review should occur whenever circumstances change.

   

CLICK HERE FOR MODEL DNAR FORM

Reference:

• (1) Resuscitation Council (UK) 2009