DNACPR

jo.anne

Hi Is anyone able to shed some light on how long a DNACPR lasts. My nan who is 97 recently went into hospital after being confused and hallucination, at the time the paramedics asked about a DNR, I explained I did not know and would discuss with family. Whilst nan was in hospital my mum who is nan`s daughter got a call about the DNACPR and said a discussion would need to be had with family. On this occasion the outcome was good, Nan was discharged and is doing ok and the only diagnois was an infection. She had an envelope with the DNACPR where a doctor had made the decision to use the DNACPR with the reasons being Futility and Frailty and also stated she had no capacity due to hallucinating. It is a purple form and states the white part is at the hospital. My question is "does this form mean each time CPR will not be attempted on my nan? 

wilfred30

My understanding is that a DNACPR order is not necessarily 'permanent' and can be used as a temporary measure.

Having said that, at the age of 97, I don't think it's kind for anyone that age to be 'pummeled' with the force needed (which often results in broken ribs) when there is no guarantee of success.

There is something to be said for being allowed to die peacefully and with dignity IMO.

roaduser3189

The form means that in the event of a cardiac arrest CPR would be unsuccessful.. The decision was made in hospital in view of your grandmothers age, frailty and other comorbidities (illnesses). So in essence the form means that if your grandmothers heart suddenly stopped, whether at home or in a hospital then CPR would not be attempted. It's a very routine form that put in place in such situations-whether by a hospital or GP. I hope this has answered your question. 

elsien

It’s not permanent and is intended to be reviewed as the person’s health and circumstances change. 

Once she is out of hospital then it should be reviewed by her GP. This is particularly relevant if when it was put in place she was hallucinating but has now regained capacity.
However it is ultimately a medical decision. If CPR is considered futile, this means that CPR will not bring her back and medical professionals cannot be forced to provide a treatment (resuscitation) that they do not believe will work. In that case the DNACPR would state that your grandmother wished to be resuscitated but has been overruled on medical grounds.
CPR is very likely to break her ribs. If she does make it to hospital still alive then if she is old and frail it is likely that she would not be able to tolerate/be suitable for more invasive interventions such as ITU.
You and your Nan need to ask yourselves  about the balance between being helped to stay as comfortable as possible in an environment that she is familiar with, or passing away in an ambulance in pain with paramedics bouncing up and down on her chest. I’m sorry if that sounds uncaring, but that is more likely to be the reality if there is nothing in place. 

Flugelhorn

when I worked as a GP we used to have some patients with DNRs - we recorded them with the local out of hours service and it was also accessible to hospital staff via the care record ,  we used to state how long it was before it was reviewed and the OOH service used to contact us at intervals as stated (max 6 /12) to check that it was still valid / correct etc 

the problem can occur with people moving between different parts of the health service   and the fact that the DNR exists is not known to all though this is improving.

Silvertabby

My medical training is limited to Armed Forces first aid, which did include CPR.  As others have said, when done properly it's brutal and not something I would be comfortable  putting a frail 97 year old through.

I blame the popular TV medical shows for misleading the public - regardless of how old or ill the patient is, a few minutes of shouting 'code blue - clear - continue CPR - got him/her' and the patient is fine.  Sadly, that is not always the case in real life.

There are treatments available to keep your nan comfortable and happy but, please, for her sake, don't insist that the DNACPR notice be lifted.