DNR - AND

Hi I have put red dots on the spine of the care plan folder and I have escalated this to my team . I hope this helps

Yes it does thank you, do you also have a written statement or policy in place?

Julie Johnson
Staff
Alphacare NW
Head Office:27-29 Belmont Road Liverpool, L6 5BG
Regional 13 Scarsibrick new road Southport PR8 6PU
Tel: 0151 263 3400 • Fax: 0151 203 3074
Email: [log in to view email address]<mailto:[log in to view email address]> • Web: www.alphacarenw.co.uk<http://www.alphacarenw.co.uk/>;
CQC provider I.D 1-101639408 Company Registration No: 10414291
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Hi Julie , I have put a list at the front of the medication folder of all who are DNAR and also a list in the nurse station

Hello

Thank you for your help,

Julie

Julie Johnson
Staff
Alphacare NW
Head Office:27-29 Belmont Road Liverpool, L6 5BG
Regional 13 Scarsibrick new road Southport PR8 6PU
Tel: 0151 263 3400 • Fax: 0151 203 3074
Email: [log in to view email address]<mailto:[log in to view email address]> • Web: www.alphacarenw.co.uk<http://www.alphacarenw.co.uk/>;
CQC provider I.D 1-101639408 Company Registration No: 10414291
alphacarenw dss ltd td as alphacarenw

This message (and any associated files) is intended only for the use of the individual or entity to which it is addressed and may contain information that is confidential, subject to copyright or constitutes a trade secret. If you are not the intended recipient you are hereby notified that any dissemination, copying or distribution of this message, or files associated with this message, is strictly prohibited. If you have received this message in error, please notify us immediately by replying to the message and deleting it from your computer. Messages sent to and from us may be monitored

No problem Julie

Hi Julie,

I'm not sure if I can help on this one - but 'I loved' your:

'Help, its a minefield.
I seem to be having difficulty in establishing some of the rules around DNR - AND.'

I write about CPR 'all the time' - in fact, I came across your piece here, when I was screengrabbing from something I had written on DiC for a tweet-series I was writing on Twitter:

https://twitter.com/MikeStone2_EoL/status/1022776833887166464

I need to start by asking you something - where is your patient. Can your patient be anywhere at all, or are you thinking of something specific such as in a Care Home?

Julie, it seems that you are thinking about patients who are living in their own homes?

The major ethical/legal complication, hinges on whether the patient is mentally-capable with respect to 'who can see the DNACPR/AND' {and I don't like 'ANDs' for legal reasons, which I will not go into here}. if the person is legally able to decide who can see the document, the person can tell visitors 'I've got ...' and can show them. Of course, a 'happenstance visitor' probably shouldn't be able to see the DNACPR/AND. It is much more complicated - it always is - if you are trying to work out the rules if the patient lacks mental capacity to be the decision-maker.

I've just asked 2 'CPR experts' on Twitter:

https://twitter.com/MikeStone2_EoL/status/1022780173006135296

'what should I tell julie?'.

If they get back to me, I'll put what they say here [I don't think either of them are DiC 'members' so they are likely to answer on Twitter (or possibly by e-mail to me) if they chip in].

I like your question - it shows you've spotted a problem.

Hello

Thank you for your response, the environment is domiciliary care so lots of people with lots of different support needs and capacity. The question I need an response to is how do other organisations identify to staff if a DNR is in place. Simply because of the number of people staff may see in a day. Also because if staff walk in to an incident they don’t have time to look through care plans etc. to decide how to deal with any situation.

Julie

Julie Johnson
Staff
Alphacare NW
Head Office:27-29 Belmont Road Liverpool, L6 5BG
Regional 13 Scarsibrick new road Southport PR8 6PU
Tel: 0151 263 3400 • Fax: 0151 203 3074
Email: [log in to view email address]<mailto:[log in to view email address]> • Web: www.alphacarenw.co.uk<http://www.alphacarenw.co.uk/>;
CQC provider I.D 1-101639408 Company Registration No: 10414291
alphacarenw dss ltd td as alphacarenw

This message (and any associated files) is intended only for the use of the individual or entity to which it is addressed and may contain information that is confidential, subject to copyright or constitutes a trade secret. If you are not the intended recipient you are hereby notified that any dissemination, copying or distribution of this message, or files associated with this message, is strictly prohibited. If you have received this message in error, please notify us immediately by replying to the message and deleting it from your computer. Messages sent to and from us may be monitored

Hi Julie,

'The question I need an response to is how do other organisations identify to staff if a DNR is in place' is 'a hot topic' at the moment, and lots of people are coming up with 'solutions' to that one. Most involve working towards recording 'DNACPRs' within online databases, which people such as 999 can access. However, there is also a push going on at the moment, which if successful will get rid of 'DNACPR Forms' - although 'DNACPR Forms' are an utter mess, and we should be trying to have instead ADRTs refusing CPR instead of 'DNACPR Forms', the main ReSPECT Form isn't a suitable replacement for a DNACPR Form (because the ReSPECT form is about best-interests decision-making). Are you on Twitter? If you are, you should tweet your question to @DrMarkTaubert who is very involved with 'CPR' in Wales.

I'll probably send you an e-mail - the bigger problem for people who are living in their own homes, is the one 'you can see' in my 'Father and Son' survey

https://www.dignityincare.org.uk/Discuss-and-debate/download/298/

Julie,

I don't think you will necessarily get the type of clear answer you would like, but I think it might make sense for you to do something I'm about to suggest - if you do this, then should something happen in the future you can always point to 'well - I/we did try to ...'.

My suggestion is that you track down an e-mail address for your local Clinical Commissioning Group/s, and also for your local Ambulance Service, and then send an e-mail to both (the same e-mail addressed to the CCG and the AS) with a clear description of 'your concerns around CPR/DNACPR as it affects your staff', and ask them 'what are 'the rules about this in this area?''.

And I will send you an e-mail - I spend a lot of time 'discussing CPR at home' but not quite from your perspective,

Best wishes, Mike

Hello Mike you have been a great help and I have passed the information on for discussion with staff