Do not attempt cardiopulmonary resuscitation (DNACPR)

Do not attempt cardiopulmonary resuscitation is a medical order or directive which informs healthcare providers, including nurses, not to perform cardiopulmonary resuscitation (CPR) on a patient in specific circumstances.

Do not attempt cardiopulmonary resuscitation is often abbreviated to DNACPR. This is also known by other names or acronyms, including: DNAR (do not attempt resuscitation) or DNR (do not resuscitate). These terms refer to the same medical order, indicating a patient's or their surrogate's decision not to have CPR or other resuscitation measures performed if their heart stops beating or if they stop breathing. The specific terminology that is used can vary by region or healthcare facility.

A DNACPR order is put in place when a patient's medical condition means that CPR would be futile, medically inappropriate or contrary to the patient's wishes. It is meant to ensure that a patient's end-of-life care aligns with their preferences and the medical assessment

The decision to issue a DNACPR order should be patient-centred, involving discussions between the patient (if they can participate), their family and healthcare team. This is particularly important for patients with advanced illnesses or those who may not benefit from CPR. Typically, the decision to issue a DNACPR order is based on a thorough medical assessment of the patient's condition. Factors that are taken into consideration may include the patient’s:

• overall health
• severity of illness
• prognosis
• likely response to resuscitation efforts

DNACPR forms are not legally binding (Care Quality Commission (CQC), 2022). Clinical judgment is key in decision making, so the form acts as a guide to immediate decision making. It is important that the patient and/or the relatives understand the conversation about the DNACPR order and must be invited to ask any further questions. The conversation that has taken place must later be summarised in the patient’s notes by

Nurses are responsible for accurately documenting care provision (Nursing and Midwifery Council (NMC), 2018) which includes recording DNACPR orders in the patient's care plan and elsewhere, according to local policy. Accurate documentation can help to ensure that all healthcare providers are aware of the patient's wishes and the plan of care.

A DNACPR order must be completed and signed by a doctor and kept in the patient’s medical record. A physical or digital DNACPR form may be completed.

Full records must be kept of conversations and decisions agreed with the patient and if appropriate, their families and representatives. The records should be accessible to those involved in the patient’s care, so they are aware of the patient’s wishes and medical directives.

DNACPR forms can vary between hospitals. Nurses should become familiar with the forms that are used in their local area. For a DNACPR form to be valid, the following information is required:

• Personal details of the patient (ie name, date of birth, hospital, NHS number, home address)
• Contact details for the patient’s next of kin
• The rationale underpinning why a DNACPR order has been established. Usually, this is formatted as a list, allowing for all variations related to the DNACPR discussion – including if a patient does not have capacity, the patient has declined to have the conversation or in a situation in which it would cause physical or psychological harm if the conversation had been held
• Details of the healthcare professional completing the form (British Medical Association et al, 2021)

When the DNACPR form has been completed in an inpatient setting, the nurse should file it at the front of the notes,

Risks associated with a DNACPR order may concern ethical dilemmas that are related to capacity, validity of DNACPR orders and communication of the order.