Divergence in DNACPR and resuscitation policies: institutional survey in England.

IF 1.8 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES BMJ Supportive & Palliative Care Pub Date : 2025-10-27 DOI:10.1136/spcare-2024-005263

Emily Fitton, Karen Chumbley, Caroline Barry, Aneta Bartova, Ben Troke, Wayne Martin

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Abstract

Objectives: Our objective was to analyse the policies of hospitals and care homes in England as regards the use of do not attempt cardiopulmonary resuscitation (DNACPR) recommendations. We sought to identify (i) variations among policies at different institutions, and (ii) divergence of local policies from national guidance, particularly with reference to decisions either (a) to initiate cardiopulmonary resuscitation (CPR) despite the presence of a DNACPR recommendation, or (b) not to initiate CPR in the absence of a DNACPR recommendation.

Methods: We conducted a survey of 14 DNACPR and/or resuscitation policies, drawn from care homes, NHS trusts and hospices.

Results: Many of the policies we surveyed diverge significantly from national guidance. Some require that CPR be administered in all cases where no DNACPR recommendation has been made. Others fail to specify that CPR may be appropriate even in the presence of a DNACPR recommendation.

Conclusions: Local DNACPR policies currently place both patients and healthcare professionals at significant risk.

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DNACPR和复苏政策的分歧：英国的机构调查。

目的：我们的目的是分析英国医院和护理院关于使用不尝试心肺复苏（DNACPR）建议的政策。我们试图确定(i)不同机构政策之间的差异，以及（ii）地方政策与国家指导的差异，特别是在(a)尽管有DNACPR建议，但仍启动心肺复苏（CPR）或(b)在没有DNACPR建议的情况下不启动心肺复苏的决定方面。方法：我们对来自护理院、NHS信托和临终关怀医院的14份DNACPR和/或复苏政策进行了调查。结果：我们调查的许多政策与国家指导意见存在显著差异。有些要求在没有DNACPR建议的所有病例中实施心肺复苏术。另一些则没有明确指出，即使有DNACPR的推荐，心肺复苏术也可能是合适的。结论：当地的DNACPR政策目前将患者和医疗保健专业人员置于重大风险之中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Supportive & Palliative Care Medicine-Medicine (miscellaneous)

CiteScore

4.60

自引率

7.40%

发文量

170

期刊介绍： Published quarterly in print and continuously online, BMJ Supportive & Palliative Care aims to connect many disciplines and specialties throughout the world by providing high quality, clinically relevant research, reviews, comment, information and news of international importance. We hold an inclusive view of supportive and palliative care research and we are able to call on expertise to critique the whole range of methodologies within the subject, including those working in transitional research, clinical trials, epidemiology, behavioural sciences, ethics and health service research. Articles with relevance to clinical practice and clinical service development will be considered for publication. In an international context, many different categories of clinician and healthcare workers do clinical work associated with palliative medicine, specialist or generalist palliative care, supportive care, psychosocial-oncology and end of life care. We wish to engage many specialties, not only those traditionally associated with supportive and palliative care. We hope to extend the readership to doctors, nurses, other healthcare workers and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, paediatrics, primary care, psychiatry, psychology, renal medicine, respiratory medicine.