‘More can be done’ in Wales to improve do not resuscitate decision making processes, Healthcare Inspectorate Wales (HIW) has said.

HIW launched the Review of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Decisions for Adults in Wales last year, with the report published on 23 May.

The review explored whether patients are actively involved in decision making about DNACPR and whether those decisions are clearly recorded and communicated between healthcare professionals. The findings highlight “clear examples of noteworthy practice across Wales, however, there is room for improvement.”

The review found there is a “need to strengthen communication about DNACPR decisions across healthcare teams, and with patients and their loved ones, to ensure people fully understand the reasons for the decision and the plans about care.”

A key area and focal point during the review, and one where improvement is required, is the need for accurate and effective recording on DNACPR forms.

HIW reviewed approximately 280 forms and found “inconsistencies in the quality of recording key information.”

“Some were completed well, but others were incomplete, or it was difficult to read the written information,” the report said.

“Understanding a patient’s wishes at the end of their life is a fundamental element of good care,” HIW said.

“We found more can be done to improve people’s awareness of DNACPR, and their access to information resources, so that they can come to terms with and understand the DNACPR decision process.

“Whilst the review identified that resources are available, it was disappointing that three quarters of respondents to our public survey said they were not provided with supporting information about the decision not to resuscitate.”

Alun Jones, Chief Executive of Healthcare Inspectorate Wales said: “Understanding a patient’s wishes at the end of their life is an essential element of good care, and I expect health boards, trusts, and Welsh Government to carefully consider the content of this report and the overall findings from our review.

“I also expect health boards and trusts to consider the feedback from staff and the public highlighted throughout the report, to consider how these can influence improvements within the DNACPR decision making process.”