'Do not resuscitate' order not communicated to care home
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I was saddened to read about the case of an 86 year old dementia sufferer from Devon who underwent cardio-pulmonary resuscitation (CPR) against her wishes due to an apparent miscommunication between Royal Devon and Exeter Hospital and the Devon community care home in which she lived.
An inquest heard that the lady, Mrs Robson, who died in February 2010, had been a recent in-patient at the Royal Devon and Exeter Hospital at which time a 'Do Not Attempt Resuscitation' (DNAR) order was made in line with her previously expressed wishes. This means, should her heart stop beating, that no attempt would be made to restart it.
This fact was not communicated to her care home on discharge therefore, no consideration was given to putting in place the same arrangement in the community. As a result, care staff and paramedics felt duty-bound to attempt CPR when the need arose which meant that her final moments, rather than being peaceful and with her daughter, were distressing for all concerned.
DNAR orders are used in hospitals, if appropriate and with the involvement of the patient and their family if possible, when it is not considered to be in the patient's best interests, or if it is against the patient's express wishes, to be resuscitated in the event of a cardiac arrest. Such orders however are not transferable to the community, in which a separate order must be made by the patient's GP.
It would therefore seem that the care staff and paramedics in the case of Mrs Robson acted appropriately under the circumstances however, had the full situation been communicated to the community team by the treating hospital, Mrs Robson's GP could have made a further DNAR order and Mrs Robson may have had the opportunity to spend her final minutes in peace and dignity with her family.
This case illustrates not only the shortfalls in communication often found when care is transferred from hospitals to the community, but also the importance of making your wishes known to family, friends and carers in terms of your ongoing health care and in particular, end of life care.
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