Clinical update
CPR Essential facts
What’s new? Updated guidance has been published to help doctors and nurses take difficult decisions on when to attempt CPR. Developed by the RCN, the British Medical Association and the Resuscitation Council UK, it emphasises the importance of planning in advance whether or not to give CPR, and involving the patient or their representatives in these decisions.
When to make a decision not to give CPR A decision that CPR will not be attempted – because the risks outweigh the benefits – should be made only after careful consideration of all factors relevant to the patient’s current situation and after discussion with the patient or with those close to a patient who lacks capacity. Factors to be considered include the likelihood of restarting the person’s heart and breathing for a sustained period, and the likelihood of recovery.
Expert comment Maureen Talbot is senior cardiac nurse at the British Heart Foundation
Find out more Decisions relating to CPR guidance (third edition) (October 2014) www.resus.org.uk/ pages/dnacpr.htm ISTOCK
Cardiopulmonary resuscitation (CPR) is a treatment to restart the heart after cardiac arrest. Cardiorespiratory arrest is part of the final stage of dying, and health professionals can be involved in extremely difficult decisions about whether to give CPR to people when their heart stops or they stop breathing. It can be distressing for patients and people close to them. The survival rate of CPR is relatively low, and it also carries the risk of internal fractures, ruptures and long-term brain damage.
Causes/risk factors The guidance says that if cardiorespiratory arrest occurs unexpectedly, CPR will almost always be attempted. Identifiable risks of cardiac or respiratory arrest include an underlying incurable condition such as cancer or advanced heart failure, a history of myocardial infarction or stroke, or a current clinical condition such as overwhelming sepsis. If there is a risk of cardiac or respiratory arrest, it is important to make decisions about CPR in advance whenever possible.
How you can help your patient The guidance emphasises the value of making anticipatory decisions about CPR as an integral part of good clinical practice. Patients, or their representatives, should be part of the decision-making process. It states that leaving people in the default position of receiving CPR if their heart or breathing stops, regardless of their views and wishes, denies them the opportunity to refuse treatment. Nurses should keep careful documentation and ensure effective communication of decisions about CPR. ‘It is hugely important that the patient’s wishes and decisions are taken into consideration and followed. ‘Nurses have an important role when it comes to discussing these issues with patients, as they have often had the opportunity to develop a relationship with patients and their families.
Resuscitation Council (UK) www.resus.org.uk British Heart Foundation www.bhf.org.uk RCN Publishing articles Cardiopulmonary resuscitation in end of life care (2012) Reynolds J, Croft S. Nursing Standard dx.doi.org/10.7748/ ns2012.08.26.51.35.c9242 How to use advance care planning in a care home (2013) Storey L, Sherwen E. Nursing Older People www.tinyurl.com/pubv3f7 Good practice in helping clients cope with terminal illness (2013) Marriott A et al. Learning Disability Practice www.tinyurl.com/phj63rp
‘If a nurse notices that a “do not resuscitate” discussion has not taken place and believes it should, then they need to take steps to ensure this is started by an appropriate person – either themselves, a doctor or another member of staff. ‘Questions from patients on resuscitation should not be avoided, as they have the right to discuss their wishes.’
NURSING 26other :: voluses 29 no 13 :: permission. 2014 19 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 19, 2015. For personalnovember use only. No without Copyright © 2015 RCNi Ltd. All rights reserved.
CPR Essential facts
What’s new? Updated guidance has been published to help doctors and nurses take difficult decisions on when to attempt CPR. Developed by the RCN, the British Medical Association and the Resuscitation Council UK, it emphasises the importance of planning in advance whether or not to give CPR, and involving the patient or their representatives in these decisions.
When to make a decision not to give CPR A decision that CPR will not be attempted – because the risks outweigh the benefits – should be made only after careful consideration of all factors relevant to the patient’s current situation and after discussion with the patient or with those close to a patient who lacks capacity. Factors to be considered include the likelihood of restarting the person’s heart and breathing for a sustained period, and the likelihood of recovery.
Expert comment Maureen Talbot is senior cardiac nurse at the British Heart Foundation
Find out more Decisions relating to CPR guidance (third edition) (October 2014) www.resus.org.uk/ pages/dnacpr.htm ISTOCK
Cardiopulmonary resuscitation (CPR) is a treatment to restart the heart after cardiac arrest. Cardiorespiratory arrest is part of the final stage of dying, and health professionals can be involved in extremely difficult decisions about whether to give CPR to people when their heart stops or they stop breathing. It can be distressing for patients and people close to them. The survival rate of CPR is relatively low, and it also carries the risk of internal fractures, ruptures and long-term brain damage.
Causes/risk factors The guidance says that if cardiorespiratory arrest occurs unexpectedly, CPR will almost always be attempted. Identifiable risks of cardiac or respiratory arrest include an underlying incurable condition such as cancer or advanced heart failure, a history of myocardial infarction or stroke, or a current clinical condition such as overwhelming sepsis. If there is a risk of cardiac or respiratory arrest, it is important to make decisions about CPR in advance whenever possible.
How you can help your patient The guidance emphasises the value of making anticipatory decisions about CPR as an integral part of good clinical practice. Patients, or their representatives, should be part of the decision-making process. It states that leaving people in the default position of receiving CPR if their heart or breathing stops, regardless of their views and wishes, denies them the opportunity to refuse treatment. Nurses should keep careful documentation and ensure effective communication of decisions about CPR. ‘It is hugely important that the patient’s wishes and decisions are taken into consideration and followed. ‘Nurses have an important role when it comes to discussing these issues with patients, as they have often had the opportunity to develop a relationship with patients and their families.
Resuscitation Council (UK) www.resus.org.uk British Heart Foundation www.bhf.org.uk RCN Publishing articles Cardiopulmonary resuscitation in end of life care (2012) Reynolds J, Croft S. Nursing Standard dx.doi.org/10.7748/ ns2012.08.26.51.35.c9242 How to use advance care planning in a care home (2013) Storey L, Sherwen E. Nursing Older People www.tinyurl.com/pubv3f7 Good practice in helping clients cope with terminal illness (2013) Marriott A et al. Learning Disability Practice www.tinyurl.com/phj63rp
‘If a nurse notices that a “do not resuscitate” discussion has not taken place and believes it should, then they need to take steps to ensure this is started by an appropriate person – either themselves, a doctor or another member of staff. ‘Questions from patients on resuscitation should not be avoided, as they have the right to discuss their wishes.’
NURSING 26other :: voluses 29 no 13 :: permission. 2014 19 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 19, 2015. For personalnovember use only. No without Copyright © 2015 RCNi Ltd. All rights reserved.
