2.5 Explain what is meant by a ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) order

This guide will help you answer 2.5 Explain what is meant by a ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) order.

A DNACPR order stands for “Do Not Attempt Cardiopulmonary Resuscitation.” It is a medical instruction placed in a person’s health records. It tells healthcare staff not to attempt CPR if that person’s heart stops beating or they stop breathing. CPR can include pressing down hard and fast on the chest, giving rescue breaths, and sometimes delivering shocks to the heart using a defibrillator.

The order means that if the person has a cardiac or respiratory arrest, the healthcare team will not perform CPR. Other treatments and care will still go ahead. The aim is to provide the right care for the person, without attempting CPR, which might not be in their best interests.

Purpose of a DNACPR Order

The main purpose of a DNACPR order is to:

• Respect the person’s wishes
• Avoid treatments that have little or no chance of success
• Reduce unnecessary pain or distress at the end of life
• Allow a peaceful and dignified death

For some people with severe illness or advanced frailty, CPR may not work. For others, it might only extend life for a short period, possibly causing discomfort. The decision is made to match treatment to what is medically realistic and ethically right for the person.

How a DNACPR Decision is Made

A DNACPR order is not made without thought. It involves discussions between the person, their doctor, and sometimes their family or appointed advocate. A doctor makes the clinical decision, but the person’s wishes should be considered wherever possible.

The steps often involve:

• Medical assessment of the person’s health and prognosis
• Discussion about the likely success of CPR
• Talking about the possible outcomes if CPR succeeded
• Considering the person’s quality of life after resuscitation
• Recording the decision in the person’s medical notes

These discussions can take place in hospitals, care homes, GP surgeries, or even at home for those receiving community healthcare.

Who Can Make a DNACPR Decision

In the UK, a DNACPR order is usually made and signed by a senior doctor or consultant. The healthcare team may be involved in the discussion, but the final responsibility lies with the lead clinician. In some cases, specially trained nurses with relevant authority can be part of making the decision.

The person’s legally appointed attorney for health and welfare, through a registered lasting power of attorney (LPA), may be consulted. If the person lacks mental capacity, the decision will be made in their best interests following the Mental Capacity Act 2005.

The Role of Consent and Capacity

Mental capacity means being able to understand, retain, and weigh up information to make a decision, and being able to communicate it. If the person has capacity, they can express a wish for or against CPR. This will be taken seriously.

If the person has capacity and refuses CPR, their refusal is legally binding. It can be recorded in an advance decision to refuse treatment (ADRT). A DNACPR form supports this by alerting healthcare teams quickly.

If the person lacks capacity, the healthcare team will look at:

• Any advance statement or ADRT
• The views of those close to the person
• The person’s values and known wishes
• The clinical judgement about treatment success and impact

How Staff Use a DNACPR Order

The DNACPR form is often kept in a clear, visible place in the person’s medical record, or if in a care home or at home, somewhere paramedics and staff can find it quickly. If the heart or breathing stops, staff check for a valid DNACPR order before taking action.

If there is no DNACPR order present, the default response is to start CPR immediately. This is why it is important for the form to be accessible.

In hospitals and care settings, DNACPR orders are recorded in both paper and electronic records. In the community, a standardised form is often used so ambulance staff can recognise it.

What a DNACPR Order Does Not Mean

A DNACPR order applies only to CPR. It does not mean “do not treat”.

People with a DNACPR order still receive:

• Hospital admission if required
• Pain relief
• Antibiotics
• Fluids and food where possible and appropriate
• Help with breathing such as oxygen, if suitable
• Comfort care and emotional support

The healthcare team will continue to address any treatable conditions, manage symptoms, and maintain the quality of life.

Why a DNACPR Order Might be Put in Place

There are several common reasons for having a DNACPR order:

• Severe illness where CPR would have no benefit
• Advanced stage of a disease such as cancer or dementia
• Frailty linked with very low chance of surviving CPR
• The person’s personal choice to avoid CPR
• Risk that CPR would cause more harm than benefit
• Poor quality of life anticipated after CPR

The decision is always based on the individual situation rather than a person’s age alone.

The Legal and Ethical Framework

DNACPR orders are supported by law and national health guidelines. The law requires that:

• Patients who have capacity must be involved in the decision
• Decisions must respect human rights under the Human Rights Act 1998
• Discrimination based on age or disability must not happen
• Records must be clear and accessible to the relevant care teams

The General Medical Council (GMC), Resuscitation Council UK, and NHS England provide clear guidance for healthcare workers.

Recording and Reviewing a DNACPR Order

Once agreed, the DNACPR order is recorded on a standard form. In most NHS areas, the form is bright and easy to recognise. It should include:

• Full name, date of birth, and NHS number of the patient
• Date of the decision and signature of the clinician
• Notes of the discussion and who was involved
• Reason for the decision

These orders are reviewed regularly. If the person’s health changes, the order might change too. A recovery or improvement in condition may mean a DNACPR is no longer needed, while worsening health might confirm its benefit.

DNACPR in Emergency Situations

In an emergency, quick decisions are vital. If there is no DNACPR form present or accessible, the healthcare team will attempt CPR. This is because the default position is to try to save life unless there is a clear instruction not to.

Paramedics and hospital staff are trained to look for DNACPR forms immediately when they arrive. If one is found and is valid, they will not begin CPR. They will provide other treatments as needed.

DNACPR and Advance Care Planning

DNACPR forms are often part of a wider advance care plan (ACP). An ACP records a person’s wishes, priorities, and preferences for future care and treatment. The DNACPR is one element of that plan.

During an ACP discussion, people can also talk about place of care, preferred place of death, symptom management, and other treatment options. This can give peace of mind to the person and their family.

The Emotional Impact of DNACPR Decisions

Talking about DNACPR can be emotionally difficult. Families may feel that agreeing to the order means “giving up” on the person. It is important to stress that DNACPR is about focusing on care that helps and avoiding treatment that is likely to cause suffering without benefit.

Healthcare workers need to handle these conversations with sensitivity, clarity, and honesty. Allowing time to discuss and answer questions helps reduce distress.

The Worker’s Role in Supporting DNACPR Decisions

As a health and social care worker, your role may include:

• Being aware of DNACPR orders and where to find them
• Respecting and following the instruction in emergency situations
• Providing compassionate care to the person and their family
• Passing on clear information to other members of the care team
• Maintaining confidentiality at all times
• Encouraging people to discuss their wishes while they have capacity

You are not expected to make medical decisions about DNACPR. Your responsibility is to support and follow the plan.

DNACPR Across Different Care Settings

DNACPR orders apply in hospitals, care homes, hospices, and in people’s own homes. The form should follow the person wherever they receive care. Many areas use a standard form to avoid confusion.

In care homes, staff may keep the document in a clearly marked section of the care plan. For people at home, it might be kept near the phone or in an agreed visible place so ambulance staff can find it quickly.

Common Misunderstandings

Some myths and misunderstandings about DNACPR include:

• “It means no treatment at all” – This is wrong. It only covers CPR.
• “It is permanent” – In truth, it can be reviewed and changed.
• “It is decided based only on age” – It is based on health and medical judgement, not age alone.
• “Families can demand CPR even if it will not work” – The final decision rests with the clinician if CPR is judged futile.

Clearing up these misunderstandings helps avoid distress and ensures the person’s wishes are met.

Final Thoughts

A DNACPR order is a clear medical instruction that ensures CPR will not be attempted if it would not work or would cause more harm than benefit. It respects the person’s wishes and focuses on appropriate, compassionate care. It does not mean that treatment stops. People with DNACPR orders continue to receive full care and support.

For health and social care workers, understanding what DNACPR means is part of providing respectful and safe care. You play an important role in recognising the order, supporting the person and their family, and making sure the decision is followed. This protects dignity and promotes the right care at the right time.