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Good capacity recording is fundamental to DNACPR, Welsh regulator concludes

How well details are recorded relating to a person’s mental capacity is fundamental to correct Do Not Attempt CPR decisions, the Welsh health regulator has said.

In a review of DNACPR decisions, the watchdog finds inconsistent record-keeping for those lacking capacity. It states that some forms and clinical records were contradictory, inconsistent, or lacked evidence of a mental capacity assessment having been undertaken.

“On the records reviewed, we are not assured that the DNACPR decision making process is always completed in line with the all-Wales Policy for patients who were deemed to lack capacity.”

Good records contain concise, and thorough explanations of patient discussions, and detailed narratives in patient records to support the DNACPR form. However, many records were incomplete, or difficult to read.

The review also called for improved communication about DNACPR decisions across healthcare teams, and with patients and their loved ones: almost a third of staff responding to a survey felt that communication across healthcare teams regarding DNACPR was not at all effective; three quarters of public respondents said they were not provided with supporting information about the decision not to resuscitate; half said their accessibility needs were not considered during DNACPR discussions, and most said their communication needs or preferences were not discussed.

The Welsh regulator suggests initiating DNACPR conversations with patients earlier in their illness, rather than towards the end of their life, and improving training and support for staff around DNACPR discussions.

Done well, DNACPR discussions can be a positive experience, offering clarity at a time of uncertainty, to ensure that distractions are limited at such an important and emotive time, it concludes.

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