1. 24/09/14Tracy Livingstone All Wales DNA/CPR Policy The story so far……….

2. Outcomes The Context - Where have we come from? Where are we now? What will happen in the future? Any questions?

3. The Context

4. Where have we come from? Elizabeth Kubler Ross – ‘On Death and Dying’ 1969 “The more we are making advancements in science the more we seem to fear and deny the reality of death”

5. Before the Policy Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) decisions were being made Each organisation, service, hospital etc. had their own unique policy and documentation Documented decisions not to attempt CPR on service documentation were not always valid or accepted across service boundaries. Critical incidents occurred

6. The Process Clinicians from across Wales, supported by various experts, stakeholder and led by Dr Paul Buss, Aneurin Bevan Health Board have worked over a period of time to develop an all Wales Do Not Attempt Cardiopulmonary Resuscitation policy.

7. Were are we now? Initial consultation process closed on Wednesday 11 th June 2014 The new All Wales Do Not Attempt Resuscitation Policy is due to be sent to medical directors on October 14 th 2014 The introduction of the policy will include dissemination of patient information leaflets

8. What does the Policy Cover? CPR – Cardiopulmonary Resuscitation CPR is a technique used to maintain body’s circulation and breathing. It is a process that usually means “pressing the chest” and providing ventilation to the lungs. In some cases “defibrillation” using electric shocks and the also injections of medication may be used.

9. What is not covered? DNACPR This refers to a specific decision NOT to provide CPR in the event of a cardiac arrest. It must be made clear to all that a DNACPR decision does NOT impact on any other element of care.

10. The Background The purpose of the policy is to provide a policy framework for professionals and NHS bodies in Wales in order to enable a consistent approach to decisions relating to the provision of CPR.

11. The Aim and Purpose Whilst for every individual, death is inevitable, achieving a dignified, sensitive and shared approach to reaching a decision relating to CPR is vital for patients and those who are close to them.

12. The Risk Developing an all Wales Policy doesn’t guarantee improved communication and involvement in discussions This can only be achieved through education and emphasis on the priorities for implementation of the policy

13. Who decides about CPR? You, or your LPA health and the healthcare team looking after you can discuss if you would be likely to benefit from CPR. With you they will take into account: Your wishes Your current health Whether CPR is likely to restart your heart and breathing, and for how long Also whether CPR will help you live longer in a way you can enjoy. If your healthcare team think CPR may work for you, they will want to know what you think. Your wishes are very important in making this decision.

14. Who decides about CPR? If your healthcare team are sure CPR won’t work, they may decide in advance that it should not be tried. They will write this decision on a form called ‘Do Not Attempt Cardiopulmonary Resuscitation’ (a DNACPR form). They often will wish to discuss this with you and the DNACPR form will be kept with your health records.

15. What influences the decision? CPR does not always work. In fact the chance of CPR resuscitating you will depend on: Why your heart and breathing has stopped What illness or medical problems you have (or have had in the past) Your general health

16. The Future Honest, and regular communication is key to implementation

17. Consider……. Communication as a two-way process What would you want to know? Are there ever any circumstances when you would not want to be given information? How would your health care professional know your choices

18. The Future Information needs to be:- Accessible In appropriate formats Honest In terms of the likelihood of successful resuscitation In terms of the legal standing of individual choice

19. Information Resources Available in both Welsh and English

20. Final thoughts Talking about our wishes doesn’t make them happen sooner Planning for our future care keeps us involved in the decision making Dying Matters – Lets talk about it!

21. Source for further Information http://www.wales.nhs.uk/sitesplus/861/pag e/73643 - (link to draft documentation) http://www.wales.nhs.uk/sitesplus/861/pag e/73643 http://www.wales.nhs.uk/sitesplus/867/ope ndoc/240198 - (Quick reference guide) http://www.wales.nhs.uk/sitesplus/867/ope ndoc/240198 Wales NHS web-site

22. Thank you Any questions?