A quick one for the medical fraternity on here.

My grandad had a heart attack recently, spent a week or so in hospital, another week in a recovery “home” and is now back in his own house. He got a bag full of medicine to take home from the halfway place and in there are the doctor’s notes from his stay. Amongst other things, they state he’s agreed to Do Not Resuscitate and the box has been ticked to say this has been discussed with my grandad and his family. Except he hasn’t agreed and it hasn’t been discussed.

He’s phoned the home to find out what’s going on but they’ve palmed him off with some story or other and have basically said it’ll be a week or so before his record can be amended. All well and good, but what if he has another emergency before then?

What can we do about a) some doctor seemingly making life & death decisions without proper consent, and b) having my grandad’s record amended immediately?

Is their a DNR in with his discharge items(?

Should have a Doctors signature next to it, contact the doctor

Yes, his notes (or a copy of) were in his discharge bag.
Doctor is away from work, dunno if it’s holiday or illness, but that’s the nub of the “we can’t sort it for a while” story.

Speak to PALS (patient advice and liaison service) at the hospital. That could have been a catastrophic ‘mixup’.

A DNR is a seprate document altogether, without one it’s invalid.

He’s in Sheffield, I’m in Fife. I’d better check exactly what he’s got.
Would DNR not be written on notes then?

It might be noted on the notes but it’s a form usually in a yellow envelope.

When people are discharged, not sure if same throughout country, there is usually a bright envelope given with a DNAR form in it and advised leave somewhere prominent for carers/ medics etc to see if needing to attend – like mantlepiece/ bedside locker. Think that is what Drac is referring to? – so if one of them not present then it will not be applied and active treatment will be engaged if appropriate.
Edit- Drac added while I was typing.

I’m a paramedic in Yorkshire. Unless he has a nice A4 document with a red border (not a photocopy) he’s getting resuscitated (if it came to that).

There is a case for assigning dnar to patients in cases of medical futility, but it should be discussed openly with patients and their families. Check with gp on Tuesday, it’ll be fine.

Cheers folks. I’ll just tell him to bin anything he has with DNR on and we can sleep a little easier.

As the guys have said but also get on to the hospital and home tomorrow first thing and do not take no for an answer to ensure that the DNAR is removed. Dunno where you are but this would be on his electronic notes in ~Scotland as well

would the CQC be appropriate in this case?

http://www.cqc.org.uk/

OP have you spoken openly to your Grandad as to why a DNR was done?

He could have potentially been involved in the decision making process, and for the DNR to have been considered, there must have been some real reason for it.

would the CQC be appropriate in this case?

Nope, they’re not for individual complaints more like a governing body.

OP have you spoken openly to your Grandad as to why a DNR was done?

He’s adamant he’s not discussed it with anyone. Found the form in his discharge bag and phoned my dad all in a panic.

Is he of sound mind IE could he have forgotten the discussion?

It used to be common practice to put DNAR orders on patients without discussion but nowadays the presumption is for discussion although it still can be done without but needs good reason to do it without discussion and this must be recorded in the notes.

I would be onto all relevant folk in the morning and get the DNAR rescinded if thats what he wants.

No, he’s fully compos mentis. Only thing I can think is his age, as he’s now 90. I wouldn’t have thought that alone could be enough to have the decision made for him though…

Where was it common practice?

If he has the DNR which sounds like he could destroy it, they must have the original for it to be valid.

For a paternalistic old school consultant it might be enough. It would also be wrong to decide to DNAR on that basis

Where was it common practice – all over the health service in acute hospitals 20+ years ago. Paternalistic consultants would routinely decide on resus status without discussions with the patient on the grounds it was too delicate a topic / too upsetting / the patient would not understand. Fortunately these attitudes are mostly gone now

FFS 😯

DNAR forms are a tricky area in medicine with a lot of misconceptions around them.

For your immediate situation, as bails says above, I think your best course of action would be to contact the PALS service at the hospital that treated your grandfather. IME they are very good at resolving situations like this. It’s worth contacting your grandfather’s GP as well to make his wishes clear, in case the GP has amended his records to note the DNAR.

As an aside, and contrary to popular belief, nobody has an automatic right to have CPR performed. It is ultimately the doctor’s decision whether that treatment is appropriate, not the patient’s. That being said, if a person is of sound mind then that decision should always be discussed, even if it is to say that CPR would not be offered. It sounds like that didn’t happen with your grandfather, which is disappointing.

All that being said, the default course of action where there is any doubt whatsoever is to attempt CPR.

He could have potentially been involved in the decision making process, and for the DNR to have been considered, there must have been some real reason for it.

This. Our trust is very hot on people following the DNAR policy and I’d be astonished if it’s different elsewhere.

As an aside, and contrary to popular belief, nobody has an automatic right to have CPR performed. It is ultimately the doctor’s decision whether that treatment is appropriate, not the patient’s. That being said, if a person is of sound mind then that decision should always be discussed, even if it is to say that CPR would not be offered. It sounds like that didn’t happen with your grandfather, which is disappointing.

Arogers has managed to say what I was trying to find the words to write.

For what it’s worth, CPR is undignified and unpleasant, and in those at extremes of age is likely to be ultimately unsuccessful, even if there is a return of spontaneous circulation. Having a DNAR form doesn’t necessarily mean there are other treatment limitations in place, in any case.

DOI: Consultant in Intensive Care Medicine, and am experienced in dealing with the aftermath of CPR.

https://www.theguardian.com/healthcare-network/2016/feb/03/casualty-cpr-fails-cancer-doctors-let-patients-die

I’ll just leave this here, I can’t express my feelings on the subject better, if I reach 90yrs I’ll have signed the DNAR form myself and told my whole family my wishes.

COI consultant anaesthetist 6028115

Thankfully the last 2 posts are from people who know what they are talking about, and the Guardian article is very insightful perhaps for the OP.

The DNAR conversation is one I had with my father as he was about to be transferred from hospice to hospital for a scan to see how his cancer was progressing. I understood the implications of an attempt at CPR and he was in agreement that it would be a bad idea. The whole conversation was much easier than I might have expected.

For what it’s worth, CPR is undignified and unpleasant, and in those at extremes of age is likely to be ultimately unsuccessful, even if there is a return of spontaneous circulation. Having a DNAR form doesn’t necessarily mean there are other treatment limitations in place, in any case.

Precisely.

As others have said maybe he has had the conversation, maybe he doesn’t recall it or maybe he changed his mind. The family do not always need to be informed or sometimes a family member is but others aren’t.

It also might be for only when he was first admitted to hospital with his heart attack.

A lot more information is needed before he speak to the hospital.