When resuscitation at end of life is not wanted.

Not for Resuscitation …please!

NFR stands for ‘Not for Resuscitation’, but what else does it mean? Is there any more care or intervention or does it all end? Families who are concerned might find this information reassuring.

NFR order further explained
When someone is at the end stage of their life and it’s abundantly clear that medical treatment or surgery is no longer a viable option… this is when a doctor will open a conversation with the person involved and their significant others about exactly what they want done. Do they want a medical resuscitation team to initiate CPR (cardio-pulmonary resuscitation) in the event of cardiac arrest?

Cardio-pulmonary resuscitation
CPR is just the first step in saving a life. Once the heart has been defibrillated and is beating on its own again, and spontaneous breathing has recommenced, further interventions will be needed. This includes medications and possibly a ventilator to assist keeping the person alive.
The conversation that starts with ‘do you want active resuscitation?’ also means they don’t just stop at that point. They use all the resources available to maintain life, if that is the wish of the person and their family.

What choice does the patient have?
If the person is of sound mind, they make the choice in consultation with their doctor. The stage of their health is considered and the likelihood of further complications following resuscitation.
If the person is not able to make this choice any longer, the family members who have Medical Power of Attorney, Enduring Guardian or are Substitute Decision Makers in a persons Advanced Care Directive  will make this decision on their behalf, with help and advice from the health care professionals involved. Education is given regarding the likelihood of success of further treatment and CPR itself.

Documentation of wishes
End of life wishes are documented and signed by medical personnel in consultation with everyone concerned. An Advanced Care Directive forms a legal direction for choices to be made and should be completed if possible while the person affected is able to do this.
In a health care facility, this information is handed over to all members of the health care team to ensure that the wishes are carried out.

When no wishes have been identified
If there is no NFR order in a hospital setting and the patient is found in a collapsed state, all efforts will be made to resuscitate them, following duty of care and hospital protocols which are in line with the guidelines of the Australian Resuscitation Council.

Does an NFR order mean no further care?
An NFR order does not mean that no hydration will be given. Intravenous fluid and analgesia will be given to maintain adequate hydration and comfort. Diet will be as tolerated if any is taken at all.
Regular medications will still be given in consultation with the Specialist. Treatment of the disease process e.g chemotherapy may still be given to reduce the discomfort or debilitating symptoms of a disease progression. Nursing care will be aimed at providing comfort, maintaining skin integrity and hygiene.
An NFR order is purely related to “Not for (active) resuscitation in the event of a cardio-respiratory arrest”.

Discuss a Not for Resuscitation order early
No-one knows exactly when that moment will come. It is in the best interests of everyone if a decision has been made and documented in hospital notes or in an Advanced Care Directive.
It is the best way to ensure the wishes of the person who is at the end stage of their life are respected and acted upon. This is true for the elderly, those with terminal illness or those who have been involved in trauma.
For many, it is a difficult conversation, emotional and confronting, but there will also be a sense of relief when it has been made. Everyone wants to honour and respect the wishes of the person who is at this stage of their life.

Yellow Door Care

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