References
‘Do not attempt CPR’ in the community: the experience of ambulance clinicians
Abstract
Background:
Ambulance clinicians must make time-critical decisions concerning treatment and resuscitation. Little is known about the impact of the presence (or absence) of do-not-attempt cardiopulmonary resuscitation (DNACPR) decision forms in the community.
Aims:
To investigate ambulance clinicians' experiences of DNACPR documentation and views concerning potential future changes.
Methods:
This multi-methods study used semi-structured face-to-face interviews (
Findings:
Ambulance clinicians report that a statistically significant increase in numbers of community DNACPR forms has occurred in recent years. Most state they have not had formal DNACPR education and experience difficulties in making clinical judgments about patients at the end of life, reporting inappropriate CPR attempts and poor communication among stakeholders.
Conclusion:
Assessment of patients near the end of life with (and especially without) a DNACPR is challenging for ambulance clinicians. Education about resuscitation recommendations needs to be integrated into training and a national approach should be taken to decisions and their documentation.
Nearly half of deaths (45%) in England and Wales occur at home or in care homes (Public Health England, 2018). Ambulance services are often called to people close to death because of sudden crises, worsening symptoms or anxious caregivers, especially when community care provision is lacking (Ingleton et al, 2009). Clinicians then need to make time-critical decisions concerning resuscitation if no decision has been documented about this in advance.
Cardiopulmonary resuscitation (CPR) is the default treatment unless a do not attempt cardiopulmonary resuscitation (DNACPR) form is in place, under conditions unequivocally associated with death or where a paramedic assesses that death is imminent because of terminal illness (Joint Royal Colleges Ambulance Liaison Committee (JRCALC), 2016).
National policy recommends that patients at risk of cardiac arrest are identified, and decisions made in advance as to whether attempted CPR would be appropriate and desired. The decision is recorded on dedicated DNACPR documentation and applies only to CPR; all other appropriate patient treatment and care should continue (Resuscitation Council (UK) (RCUK), 2014).
Subscribe to get full access to the Journal of Paramedic Practice
Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.
What's included
-
CPD Focus
-
Develop your career
-
Stay informed