DNAR

Two thirds of practitioners report rise in inappropriate DNAR orders

New research has revealed that over two thirds (70%) of practitioners are seeing an increased number of inappropriate DNAR (do not attempt resuscitation) orders issued since the start of the pandemic.

Though not legally binding, a DNAR tells doctors, nurses, and paramedics not to attempt CPR.

These orders are, however, sometimes placed onto a patient’s medical records incorrectly, giving a false account of the wishes of the patient and their family.

Worryingly, although the initial spike in DNAR misuse occurred during the Covid lockdown, research conducted by Solicitors for the Elderly (SFE) appears to show that the trend is continuing now.

Jade Gani, SFE Regional Director, became “acutely aware” of this issue when an inappropriate DNAR order was placed on a loved one’s hospital records which was luckily spotted by a family member. Jade has also noticed a rise in her professional capacity and is working with SFE to highlight the important issue.

“I was horrified because no one had been notified about the DNAR order applied, not least the individual concerned”, said Gani on the incident involving her family. She continued:

“The use of blanket DNAR orders or where decisions are made without prior discussion with patients or their families is a clear breach of both the law and best practice.

It shows a complete disregard for older and vulnerable people, as well as their loved ones.”

The Care Quality Commission (CQC) investigated use of DNARs through the pandemic and highlighted a number of issues with how they were being used.

A number of issues regarding the use of DNARs were found within a review conducted by the Care Quality Commission (CQC) during the pandemic. However, Gani said the worry is that “the lessons from this haven’t been learned”. The fact that 70% of SFE members have suggested they have seen a rise in the appropriate use of DNARs seems to confirm this. Gani continued:

“Of course, the use of resuscitation or CPR may not be the appropriate course of treatment for every individual. Even if successful, the side-effects might severely affect quality of life. And other treatments may well be appropriate, such as fluids, antibiotics, admission to hospital, or even treatment in an intensive care unit.

The issue here is applying a DNAR without meaningful discussion with the patient and their family or those nominated as attorneys where a Lasting Power of Attorney (LPA) is in place.

There is a real lack of understanding about how DNARs should be used which is causing distress to vulnerable people, and ultimately failing to give them the dignity and control over the end of their lives they have a right to.”

SFE is imploring NHS Trusts and care homes to increase knowledge around how DNARs should be used and encouraging vulnerable people and their families to seek independent advice before signing an order.

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