DNACPR approach to conversation
4 step
what are the 4 steps
- to get understanding of patients condition
- ask them their views on future treatment
- talk about all potential care we are going to give - Tx options etc
- explain that some treatments wouldn’t be appropriate
step 1 dnacpr conversation
- to get understanding of patients condition
- How do you feel your health has been over the last few weeks
- Do you understand what we have been trying to do in terms of treatment recently
- How do you think things are going
step 2 dnacpr conversation
2.ask them their views on future treatment
- “have you been having any thoughts about your treatment from now on”
step 3 dnacpr conversation
- talk about all potential care we are going to give - Tx options etc
- Even though your illness is serious there are still good treatments that may help you. For example antibiotics, fluids, oxygen, medication for controlling Sx
- We want to help you to feel better and get you home with your family
step 4 dnacpr conversations
- explain that some treatments wouldn’t be appropriate
- Explain management plan
- Be positivr about Sx managaemmt and review
Our focus now is on your comfort, supporting you and your family
- We will prescribe medication for any Sx you have like pain, breathlessness, feeling restless or sickly
We will monitor your comfort regularly instead of doing blood pressure and temp checks or blood tests
mental capacity act
(2005)
- All adults are assumed to have capacity
- When there is doubt it is time and situation-specific:
- Capacity may fluctuate - “good day” vs “bad day”
If so decision should be delayed where appropriate, to a better day so they can make that decision
purpose of consent forms 1-4
Consent form 1 = Patient consenting to a procedure
Consent form 2 = Parental consent on behalf of a child
Consent form 3 = Where the patient wont have their consciousness impaired (e.g. breast biopsy)
Consent form 4 = Where the patient lacks capacity
Section 131
voluntary admission
admitted w/o formal restrictions –> free to leave any time
must have capacity + consent to admission + not resist admission
Section 2
involuntary admission
compulsory detention for ASSESSMENT
max period = 28 days = CANNOT be reviewed
application can be made by any approved MH professional or nearest relative
–> supported by 2 doctors (one must be section 12)
Section 3
compulsory detention for TREATMENT
max period 6 months - can be renewed
applicant made by AMHP or nearest relative
must be supported by 2 doctors (one section 12) (must see them in last 24 hrs)
section 4
- emergency admission for assessment (used in OP when not possible to wait for section 2)
- applicant made or AMHP or relative, requires support of only 1 doctor
- max of 72 hrs –> after which can be changed to section 2
Section 5(2)
- emergency order where INPATIENT (who was voluntary) can be detained up to 72 hrs for MHA assessment
- only 1 doctor to make application
