Where I live the DNR form is called The Yellow Envelope.I know this as my now late DH had one.We were told to keep it in a prominent place in the house (eg the mantlepiece) and he had to carry it with him if he went out.He called it his death warrant.I cannot give further details as I find it too upsetting.
The ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) form is not the same as a "digital DNR", although it can include a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) recommendation, and digital versions of the form exist.
Paramedics have a duty to try to resuscitate a patient if they collapsed in the road unless you have the new digital DNR which is registered through your GP so anyone can see it who has access to the NHS system. At home you should always make sure the folder is readily in sight and available to the paramedics or anyone else who happens to be on the scene.
Allira
Visgir1
If the family or individual, want full resuscitate and it's not in the patients best interests, the Doctors and paramedics (and maybe some other health care professionals) can make the decision not to resuscitate.
the Doctors and paramedics (and maybe some other health care professionals) can make the decision not to resuscitate.
They are not always right in their judgement either.
Yes exactly even if you opt for being resuscitated the doctor or consultant can decide it is not safe or in the patient's best interest to do so. For example a Stroke survivor who has limited quality of life would not be resuscitated as they simply could not get through. Being resuscitated is extremely hard on the body and often breaks bones and extremely severe bruising. Elderly frail patients rarely get resuscicated.
Visgir1
If the family or individual, want full resuscitate and it's not in the patients best interests, the Doctors and paramedics (and maybe some other health care professionals) can make the decision not to resuscitate.
the Doctors and paramedics (and maybe some other health care professionals) can make the decision not to resuscitate.
They are not always right in their judgement either.
Why ask us when a DNR is a life or death issue, literally! Conult a qualified medical professional like your GP....
If the family or individual, want full resuscitate and it's not in the patients best interests, the Doctors and paramedics (and maybe some other health care professionals) can make the decision not to resuscitate.
I don’t think there’s a single answer to this.
Not long ago I had big issues with what our local hospital calls a ‘respect’ form which had been completed for my husband by two doctors without his (or my) knowledge and which covered a host of other medical treatments than DNR which were being withheld from my husband until I accidentally discovered the form ( which had essentially been done fraudulently) and made a huge fuss. Only then did my husband begin to get proper investigation and treatment. The form withheld DNR, any ICU treatment, any MRIs or other scans I can’t remember the name of and basically any treatment other than palliative care. I was totally appalled and disgusted because the delay in treatment meant that my husband narrowly missed having to have his foot amputated because of spreading osteomylitis. At the time my husband was 92, previously fit and healthy.
He is still alive and doing quite well. No thanks to the two NHS doctors who completed and signed that so called ‘respect’ form.
My husband has terminal cancer and has had frequent bouts of sepsis. He was asked to sign a ‘DNR’ form in the event his sepsis caused him to fall into a coma and life support may or may not be used - given his diagnosis and the possible poor outcomes of severe sepsis.
The form turned out to be called a ‘Respect’ form and he was able to put in detail under which circumstances he would not want to be resuscitated. He was also able to plan his end of life care and where he would like to be (hospice).
We found this really useful. It meant we could have a discussion about all the possibilities ahead of us so his care can’t go in a direction we are unhappy with.
We found that the hospital were quite pushy about this form (I can understand why but it was quite upsetting) so we asked MacMillan for help and they were amazing.
Fortunately he has had no recent episodes of sepsis. He is however in the final weeks of life but still at home - all the care priorities we put on the form are being followed by the palliative care team which is reassuring.
I can’t write too much as it is so upsetting. My beautiful boy had a DNR prior to major surgery ( he was deafblind and had cerebral palsy) I think it was right at the time and ofcourse it happened . I wonder every day if I was right.
Until my mother went in to a nursing home I wasn’t aware that she had a DNR in place. Neither she nor myself had been told about it.
When I was 67 years old I went into hospital with a UTI infection and severe dehydration. I was asked if I would like Morphine to which I declined but they gave it to me anyway. Having not being used to this drug I was away with the fairies and suffering from some horrible hallucinations. I do partly remember being asked if I wanted to have a DNR put in place, I don't remember if I agreed or not because I was in no position to agreeing to sign anything. A few weeks later I was transferred to a hospital for rehabilitation where I stayed for three weeks. One day a lady doctor was doing her rounds and had my medical notes with her,as she was talking to me about my condition I saw a sheet of paper which was outlined a very bright red colour. Suddenly my memory went back to me feeling pressured to sign that document. I did not mention it to her. She then was called away to an emergency and had left my notes at the bottom of my bed. So I took a look and saw the document that I apparently signed it did not even resemble my signature. I tore it out of my file and took it home with me. What annoyed me was the pressure they put on people to sign these forms when in their early sixties. I am now in my seventies and perfectly healthy.
When my mother was end of life she had a DNR form in place. I spoke to the GP about it and he advised that it was one of the worst experiences a person in that situation could have. He said it would be traumatic for her as she was in her 90s.
It is a fact of life particularly on these forums, that incorrect information will be presented as fact. I spent my time biting my tongue at all the repeating and rehashing of purely anecdotal evidence. Most but not all, do not go to the source of so called fact printed in the press and then critically appraise the evidence. Having read reports of events I attended and realising that the press got the age, sex and injuries totally wrong I have rapidly learnt not to trust, even the so called reputable press without fact checking as much as possible.
It is wise to approach any medical advice, and that includes mine, with a very sceptical mindset and do research from a reputable source, not the press.
I wish your husband well M0nica. I hope he is treated with compassion whatever decision he makes.
The problem is that individuals use terminology loosely, so it is not clear what is being talked about, what is meant and what is accurate.
DH cannot receive cardiac compression. However I feel very uncomfortable when we talk about quality of life. How can we judge what is a satisfactory quality of life for someone else. That is a qualitiative judgement that only the recipient of the intervention can decide and it will vary from person to person.
Hwever I am reassured that DNR, is a shortened form of DNACPR so that should DH sign the form, that is the only form of resuscitation the form covers and any other method that seems appropriate will be used.
moNICA *But now there are people on GN, on another thread, talking about DNR forms applying in a variety of different situations, where it is clear that resuscitation is not limited to those having heart attacks."
I think you're confusing two separate issues, the Advance Medical Decision, and DNR.
www.nhs.uk/tests-and-treatments/end-of-life-care/planning-ahead/advance-decision-to-refuse-treatment/
A DNACPR is the full name. A DNR is merely a shortened form. CPR is not something that can be demanded, even in the absence of a DNACPR. a medical team can decide not to attempt/ to cease resuscitation attempts if they deem it to be futile. For example, if no effective compressions have been underway for 30 minutes or more, if the patient is cold and/or rigored (providing there is no suspicion of hypothermia). Or if injuries incompatible with life are present.
It is wise to understand that CPR is rarely successful, especially out of hospital, it is not like the movies where a few pumps on the chest happen and the patient walks away. It is a brutal procedure where ribs are broken and needles can be drilled into bones if IV access can not be gained via a vein.
In a fairly long career as a paramedic having attended far too many cardiac arrests I have only seen two where an older patient returned to a normal quality of life and those both happened in front of me and so skilled help was there immediately.
This of course does not mean that the public should not attempt CPR if they happen to be present at a sudden cardiac arrest.
ThanksLtEve, that’s how my GP explained it to me when I signed the DNR
Is DNACPR different from the normal DNR form?
I am very wary of patients having DNR put on their records when they may not have been in a position to agree, ie perhaps in a semi-coma, and relatives not being consulted either.
That is exactly what it means. DNACPR means do not attempt cardio pulmonary resuscitation, if he stops breathing and his heart stops beating. It only applies during a cardiac arrest which is NOT a heart attack. A heart attack, or to use the correct medical term, a myocardial infarction can result in a cardiac arrest but it is frequently not the case.
A DNACPR will not stop a medical team giving oxygen or fluids/drugs for example. If he collapses but is breathing and his heart is still beating then all efforts will be made to revive him.
Even if he stops breathing and it is an immediately reversible cause such as choking, downing or an overdose then efforts will still be made to revive him.
DH was asked to sign a DNR form because, for complicated reasons his breastbone did not rebond after bypass surgery and were anyone to press on his chest or use similar techniques to resuscitate him, it would actually kill him.
However he decided not to sign the form because, he says, while he understands that anything putting pressure on his chest is out, he would want to be resucitated, if he was in the condition he now is and there was an alternative emergency treatment he could receive and he is concerned that might not be given because of the DNR form
He is also concerned that if a sudden collapse was not heart related, he would still be refused any treatment that might revive him - oxygen, for example, or any other treatment because there was a DNR form.
When he discussed the issue with the paramedics, he was told that a DNR form only covers situations where cardio-compression might be used
But now there are people on GN, on another thread, talking about DNR forms applying in a variety of different situations, where it is clear that resuscitation is not limited to those having heart attacks.
I have looked at the NHS site and that conflicts with the advice given by the paramedics.
DH has yet to sign any form and certainly will not do it until he knows that it will only cover cardiac compression
So can anyone tell me exactly what signing a DNR form means
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