Care planning and the use of DNACPR orders in the current crisis

The Chief Executive and Registrar at the Nursing and Midwifery Council (NMC) recently expressed concern that as result of the COVID-19 pandemic, there had been reports of blanket advance care plans, including do not attempt cardiopulmonary resuscitation (DNACPR) orders, being applied to specific groups of people. This is concerning as such decisions have been made without the individual’s involvement or an assessment of their specific needs. These decisions seemed to ignore the requirement that decisions must involve the patient unless to do so would cause harm and if the clinician’s decision is that attempting CPR is futile there is an obligation to tell the patient that this is the decision.

In light of these alarming reports and due to the increasing pressures on healthcare professionals to make urgent and complex clinical decisions, the NMC and the General Medical Council (GMC) issued a joint statement on 15 April 2020 to highlight the continuing importance of advance care planning for individuals during these unprecedented times. At the same time the Department of Health & Social Care (DHSC) also issued guidance on 15 April 2020 confirming that it is unacceptable for advance care plans, including DNACPR to be applied in a blanket fashion. DHSC guidance 15 4 20

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