NHS HDL(2000)22

Health Department

Dear Colleague

RESUSCITATION POLICY

Summary

NHS Trust Chief Executives are asked to ensure that appropriate resuscitation policies which respect patients' rights are in place, understood by all relevant staff, and accessible to those who need them, and that such policies are subject to appropriate audit and monitoring arrangements.

Yours sincerely

15 November 2000
______________________________

Tel: 0131-244 2420
Fax: 0131-244 2051
E-mail: will.scott@scotland.gov.uk ______________________

1 . Recent reports have raised serious concerns about standards of resuscitation decision making in the NHS.

2. Trust Chief Executives should ensure that:

• patients' rights are central to decision making on resuscitation;
• the Trust has an agreed resuscitation policy in place which respects patients' rights;
• the policy is published and readily available to those who may wish to consult it, including patients, families and carers;
• appropriate arrangements are in place for ensuring that all staff who may be involved in resuscitation decisions understand and implement the policy;
• appropriate supervision arrangements are in place to review resuscitation decisions;
• induction and staff development programmes cover the resuscitation policy;
• clinical practice in this area is regularly audited;
• clinical audit outcomes are reported in the Trust's annual clinical governance report;
• a non-executive Trustee is given designated responsibility on behalf of the Trust Board to ensure that a resuscitation policy is agreed, implemented and regularly reviewed within the clinical governance framework.

Background and Other Information

3 . Resuscitation decisions are amongst the most sensitive decisions that clinicians, patients and relatives may have to make. Patients, whatever their age, (and where appropriate their relatives and carers) have as much right to be involved in those decisions as they do other decisions about their care and treatment. As with all decision making, doctors have a duty to act in accordance with an appropriate and responsible body of professional opinion.

4. The revised joint statement from the British Medical Association, Resuscitation Council (UK) and the Royal College of Nursing Decisions Relating to Cardiopulmonary Resuscitation (1999) is commended as an appropriate basis for a resuscitation policy. The guidance is available at http://www.resus.org.uk/pages/dnar.htm

5. Audit of the implementation of resuscitation policy should involve all relevant clinicians, and identify any areas where improvement is required - for example ensuring that decisions made on admission are properly reviewed by the clinical team and that patients, and where appropriate relatives, have been properly involved in the process. Clinical audit data should be made available to the Trust Medical Director and the clinical governance lead.

6. The Minister for Health & Community Care has asked the Clinical Standards Board
for Scotland to pay particular attention to resuscitation decision making processes as part of its forthcoming review of generic standards in NHS Trusts and the Island Health Boards.