Debate surrounding decisions not to attempt cardiopulmonary resuscitation (CPR) continues to inflame opinion and attract controversy. This is illustrated by the case of Janet Tracey where issues surrounding communication have led to the family taking legal action against Addenbrooke’s Hospital, Cambridge, United Kingdom.1
A recent survey of medical, surgical and orthopaedic medical and nursing staff demonstrated that Do Not Attempt Resuscitation (DNAR) orders may be interpreted as limiting other forms of care in addition to CPR . This was particularly true in more junior members of staff.2
We believe that hospitals and institutions caring for an elderly population should be using the terminology Do Not Attempt CardioPulmonary Resuscitation (DNA-CPR) on documents indicating CPR is not appropriate. This is a move which has been endorsed by the National Health Service (NHS) in the United Kingdom in an attempt to aid communication with staff, patients and relatives.
There is a need for good communication and clarity regarding issues surrounding end-of-life care. The use of the term DNA-CPR is more specific than DNAR and should be the preferred term for use in patient records and order forms.
John Tolliday and Hermione Denniss
Medical Registrars at Hutt Valley Hospital, Lower Hutt, New Zealand