Thread by @doctorcaldwell

#DNACPR or Will For The Final Stages of Dying?

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I observe that every Consultant struggles with DNACPR because of the negative framing. We (I?) must change the framing

@JohnLauner

Consultants & Juniors at #FortWilliam like this

You are not dying now
Your health is frail
One day your health will deteriorate badly and
We will know you are dying and
What should we do for you then?

Patient usually answers

Let me go, Doc

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Then we have to say

Sounds like you said

Me, #IWantAPeacefulDeath?

Then in this crazy UK culture you need a Red #DNACPR Licence for a Peaceful Death

‘Oh no, Doc, I’m not going to be #DNACPR’

We must reframe the whole ‘Near End of Life’ conversation @JohnLauner @TheIHI

Paint me a picture of your future ideal Dying Scene

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Of course CPR should only be used for sudden cardio respiratory arrest

At least 85% of people who die at end of living have progressive failure of the vital organs and pass slowly from living to dead. CPR then cannot work - incorrect treatment for Ordinary Dying. @djbeckett

In cardiac arrest the heart stops first and CPR may work to restore the heart before irreparable damage to the brain and other vital organs

In Ordinary Dying the vital organs progressively fail, the heart stops last and #CPR cannot work.

Doctors shouldn’t do what cannot work

The negative framing of DNACPR and patients’ and relatives misunderstanding of ‘Resus’ can result in serious distractions and detractions from care of those in failing health. I’ve observed that again this week

The #DNACPR talk can easily undermine Patient’s and Relative’s trust in Clinical Team, meaning we cannot work together on Attending the Patient, providing #GentleCare and support, giving treatments that can work to alleviate symptoms and emotional and spiritual distress

Recently aware of 4 cases in which whole multidisciplinary team agrees CPR would be totally inappropriate but patient or relative refuses to accept the Clinical Decision. Yet at same time patient or relative wants the patient ‘Not to suffer’. It’s all down to the negative DNACPR

Ward Nurses push Doctors to Do the DNACPR talk to save themselves from having to do inappropriate CPR because @nmcnews no longer respects that a good nurse can recognise Ordinary Dying or even established death @JohnLauner @iona_heath

I have even observed on wards that at end of eg ‘We’ve found you have, out of the blue, got advanced metastatic untreatable cancer’ a nurse says to Doctor ‘Can you do the red form talk NOW’.

Poor patient then has to cope with impending dying of cancer & DNACPR in a few minutes

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