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0048 Improving patient involvement in DNACPR discussions with a high fidelity simulation course
  1. Tracey Clatworthy1,
  2. Peter Isherwood1,2
  1. 1University Hospitals Birmingham NHS FT, Birmingham, UK
  2. 2University of Birmingham, Birmingham, UK


Background/context Recent legal rulings have underlined patients’ rights regarding their resuscitation status.1 It is unacceptable for a patient with capacity not to be informed of a decision relating to their resuscitation state unless the discussion will result in permanent physical or psychological harm.2

National reports have demonstrated this not to be the case,3 our own data demonstrates an unacceptably high proportion of patients not being involved in these discussions.

We have developed a high fidelity simulation course to address this issue.

Our intention is to achieve a quantifiable change in behaviour in senior clinicians and improve our communications with patients around these important concepts.

Methodology We have identified three key barriers to patients being involved these discussions:

  1. Perceived frailty and concerns about the physical and psychological impact these discussions may have for the patient.

  2. Patients surrogates requesting the healthcare team not to speak to the patient for fear of the physical and psychological impact these discussions may have for the patient.

  3. Lack of understanding of the legal framework and recent rulings.

We have designed high fidelity scenarios with specific learning outcomes, these will be delivered in conjunction with a concise explanation of the current legal framework and exploration of the issues raised during the debriefs. The learners are consultants and senior trainees within our organisation.

The program will be supported by an online learning package launched concurrently and based around video of the scenario used with subsequent explanation of the issues raised.


  1. % improvement in patients being involved in these discussions compared to our current baseline.

  2. Learner feedback from the course.

Potential impact To use high fidelity simulation to achieve a quantifiable change in behaviour and advocate patients’ rights to be involved in DNACPR decisions.


  1. England and Wales Court of Appeal (Civil Division) Decisions; Tracey, R v Cambridge University Hospitals NHS Foundation Trust [2014]

  2. Decisions relating to cardiopulmonary resuscitation. Guidance from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing. 3rd edn, 2014

  3. Fritz Z, Cork N, Dodd A, Malyon A. DNACPR decisions: challenging and changing practice in the wake of the Tracey judgment. Clin Med 2014;14(6):571–6

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