Nurses Should Decide Whether To Resuscitate Patients, New UK Guidelines

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Main Category: Nursing / Midwifery
Also Included In: Public Health
Article Date: 28 Oct 2007 - 3:00 PDT

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To date, only doctors (consultants and GPs) have been authorized to decide whether a patient is resuscitated, now new professional guidelines say experienced nurses should also be allowed to make this decision. These new guidelines were issued by the Resuscitation Council, The Royal College of Nursing (RCN) and the British Medical Association (BMA). The guidelines stress that the only nurses with this authority should be those that are suitably experienced.

As resuscitation may only be effective in one twentieth of cases, the Resuscitation Council says the guidelines are there to minimize the number of undignified and needless resuscitations of patients for whom the procedure would be of no value.

"This is about a decision that should take place when a cardiac arrest is likely to happen but the key is still - if in doubt, if you haven't had a chance to get any knowledge - you must resuscitate," said Dr Vivienne Nathanson, Director of Science and Ethics, BMA.

TV fiction and drama give people the impression that resuscitation is more effective and pleasant than it really is, according to the Resuscitation Council.

"The updated guidance states clearly that it is not always appropriate to distress a person who is dying, perhaps in the last few days of life, by discussing attempted resuscitation when clearly CPR would not be successful. The survival rate may be as low as 5% in certain individuals. The outcomes are extremely variable but they are nothing like what we see on TV. Sometimes it is a prolonged and traumatic procedure and is not always successful," said Dr David Pitcher, Honorary Secretary, Resuscitation Council.

Health professionals say that decisions about CPR (cardiopulmonary resuscitation) may be extremely distressing for patients and those emotionally close to them. The BMA says that the new guidance stresses the importance of health care professionals' transparency about such decisions - the guidelines provide advice about who should be consulted and informed when such decisions are taken.

The new CPR guidelines differ significantly from previous ones, for example:

-- The Mental Capacity Act has been included to cover the decision making with regard to patients who lack capacity. The guidance explains who needs to be involved and what procedures to take when there is no consensus (agreement) between the clinical team and an appointed welfare attorney.

-- The difference between decisions based solely on clinical factors and those based on a balance of benefits and burdens are much clearer. Clinical factors look at whether the procedure will work, while a balance of benefits and burdens assesses whether the benefits of providing CPR are greater than the potential risks.

-- There is more data about recording and communicating decisions.

-- Guidance on who can make CPR decisions is clearer now. The new guidelines allow suitably experienced nurses to make decisions if local policy allows.

Dr Peter Carter, General Secretary, Royal College of Nursing, said "With clearer guidelines and better communication within the healthcare team, this guidance should help spare patients and their families the heartache and indignity of repeated and sometimes unnecessary resuscitation attempts. It will also mean that when a suitably experienced nurse believes that CPR will not be successful, they will be able to respond appropriately without having to wait for a GP or consultant. This joint guidance should reduce some of the traditional glitches in communicating resuscitation decisions across different sectors of the health service. It also recognizes the important part that nurses play in decisions related to resuscitation and will allow experienced nurses to make key decisions in conjunction with their patients if appropriate."

-- Click here see the full guidance (BMA Web Site)

www.bma.org.uk
www.rcn.org.uk
www.resus.org.uk

Written by: Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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