Important: for nurses re decisions relating to Cardiopulmonary Resuscitation
Some of you will be aware of the case below which came before the NMC in November 2014:
The Registrant was employed as a registered general nurse at a residential nursing home. During the night shift from 4 December 2012 to 5 December 2012, the Registrant was the sole nurse on duty at the home along with five healthcare assistants. Patient A was a resident at the home and, during the night in question, she had been ill with a suspected urinary tract infection. During the morning of 5 December 2012, the Registrant was alerted by a healthcare assistant to concerns in relation to Patient A’s condition. The Registrant attended Patient A and identified that she had passed away. The Registrant was subsequently referred to the NMC. The allegations in relation to her practice in respect of Patient A were threefold. Firstly, it was alleged that the Registrant had failed to administer CPR to Patient A. Secondly that the Registrant failed to dial 999 following her discovery that Patient A had passed away and, thirdly, that she did not complete an incident report or any documentation in relation to the incident. It was submitted that there was evidence that the Registrant had made a decision not to attempt to resuscitate Patient A or to call an ambulance without conducting a proper examination or assessment of the patient’s condition.
This has been the subject of some discussion in governance meetings across DCHS and I thought it would helpful to share the latest NMC/ RCN guidance with you all.
Joint NMC/RCN statement regarding Decisions Relating to Cardiopulmonary Resuscitation
NMC Statement on CPR decisions
Following recent publicity relating to fitness to practise cases regarding resuscitation we felt it was important to clarify the current position. Clear new guidance was developed jointly in 2016 by the Resuscitation Council, BMA and RCN called ‘Decisions relating to cardiopulmonary resuscitation’ (https://www.rcn.org.uk/professional-development/publications/pub-005688). The NMC is supportive of this guidance.
While the guidance recommends that: "Where no explicit decision about CPR has been considered and recorded in advance there should be an initial presumption in favour of CPR", the guidance clarified: “ ‘…an initial presumption in favour of CPR’ …does not mean indiscriminate application of CPR that is of no benefit and not in a person’s best interests.”
Section 8 of the guidance states that: "…there will be cases where healthcare professionals discover patients with features of irreversible death – for example, rigor mortis. In such circumstances, any healthcare professional who makes a carefully considered decision not to start CPR should be supported by their senior colleagues, employers and professional bodies."
All registered nurses and midwives must uphold the standards in the Code (https://www.nmc.org.uk/standards/code/) which include always practising in line with the best available evidence and keeping their knowledge and skills up to date.
It is the duty of health and care provider organisations to have appropriate evidence based policies in place, and to provide the appropriate education and training for nurses working in an environment in which they may encounter death or cardiac arrest.
DCHS has the following policies to support you in your decision making:
If you have any issues or concerns please do not hesitate to contact your line manager, Michelle O’Connor (Senior Matron Clinical and Professional Standards), Sue Allen, (Safe Care Matron) or myself.
Deputy Chief Nurse
Mobile: 0797 067 0726
Address: Walton Hospital, Whitecotes Lane, Chesterfield, S40 3HW