Documentation of resuscitation decision-making: a survey of practice in the United Kingdom

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders have been in use since the 1990s. The Resuscitation Council UK (RCUK) provides guidance on the content and use of such forms in the UK but there is no national policy.

To determine the content of DNACPR forms in the UK, and the geographical distribution of the use of different forms.

All acute trusts within the United Kingdom were contacted via a combination of email and telephone, with a request for the current DNACPR form along with information about its development and use. Characteristics of the model RCUK DNACPR form were compared with the non-RCUK DNACPR forms which we received. Free text responses were searched for commonly occurring phrases.

118/161 English NHS Acute Trusts (accounting for 377 hospitals), 3/6 Northern Irish NHS Acute Trusts (accounting for 25 hospitals) and 3/7 Welsh Health Boards (accounting for 73 hospitals) responded. All Scottish hospitals have the same form. All responding trusts had active policies and have a DNACPR form in use. 38.9% of respondent hospitals have adopted the RCUK form with minor amendments. The remainder of the responding hospitals reported independent forms. 66.8% of non-RCUK forms include a transfer plan to ambulance staff and 48.4% of non-RCUK forms are valid in the community. Several independent trusts submitted DNACPR forms with escalation plans.

There is wide variation in the forms used for indicating DNACPR decisions. Documentation is rapidly evolving to meet the needs of patients and to respond to new evidence.