As with any new job you will find that there are many new abbreviations which you need to get to know. Live-in care work is no different, with many titles and labels being abbreviated to make it easier and quicker to talk about.
So, what’s a DNAR?
This stands for ‘Do not attempt resuscitation’. You may have known this before as just DNR. It changed in 2005. It is also the same as the DNACPR order.
A DNAR document must be signed by a doctor. It informs a medical team that they should not attempt cardiopulmonary resuscitation (CPR). Because of the simplicity of the form, it is very clear to healthcare staff how they decide on the help to give.
Without one of these documents in place a healthcare team will always attempt to resuscitate.
You may find this at any of the clients you are placed with, and indeed, it is always worth asking if there is a DNAR in place when you arrive. Simply because of the nature of live-in care there is always the possibility of your client passing away, so knowing whether they want to be resuscitated or not is important.
Something to remember about the DNAR is that while it will preclude anyone from attempting to resuscitate someone, it does not prevent them from administering other types of medication to make someone pain-free and comfortable.
What does a DNAR form look like?
In the UK there are National guidelines which recommend that the DNAR form is the same throughout the country so that they can be easily recognised. However, there are still several different types depending on where you find yourself.
A DNAR can be written for a specific time period or for an indefinite period. Those written for specific times will need to be reviewed and either re-signed by the doctor or discarded if they no longer apply.
A DNAR which is written with an indefinite period in mind does not need to be reviewed.
If you need to take your client to hospital, you should make sure that you also take the DNAR.
What’s the purpose of a DNAR?
In the right circumstances the form is used to ensure that death is dignified and peaceful. It is also used when someone specifically does not want to be resuscitated or given CPR, perhaps in the case of advanced illnesses.
It is useful when the risk and outcome of CPR are worse than any potential benefits.
CPR may not be appropriate when someone is at risk from respiratory or cardio arrest should it be applied.
To sum up
Hospitals are legally obliged to follow the instructions of the DNAR, so if you need to take your client to hospital or they are admitted to a care home, the DNAR form should be produced along with all other medical records and medication.
It is a good idea to know where the DNAR document is kept at your client. Some advocate keeping it in the freezer, or at least in an obvious place such as stuck on the fridge, so that healthcare staff can easily find it. It’s not a good idea to keep it in the filing cabinet or anywhere you or the next carer may not find.
If you need to call an ambulance for any reason and cannot produce the DNAR document they are obliged to start CPR, whether your client agrees or not, so you should always make sure that you know where the form is kept and pass this information on to the next carer.
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