GENERAL MANUAL POLICY

Issued By: Executive Director

PREAMBLE

As health care providers, we take seriously our ethical obligation to provide quality care to all the residents who make this facility their home. We endeavour to assist families in making the appropriate selection of a facility that will meet the individual needs of their family member. We feel that we are able to provide quality care for our residents, many of whom will make this facility their final home.

Saint Vincent’s Nursing Home believes that cardiopulmonary resuscitation (CPR), like all other treatment decisions, remains the choice of the individual resident, or in the case of an incompetent resident, the designated proxy decision-maker or legally recognized next-of-kin. While present research literature clearly suggests that resuscitation attempts are often medically ineffective (unsuccessful), we believe as professional care providers, that we have both a moral and a professional obligation to support our residents’ right to make decisions about their own health care and treatment.

However, there are some services that we do not provide on site, such as CPR. We believe that there are only two valid reasons not to offer this particular treatment and it is our duty to clearly articulate our position to all residents and their families upon admission to this facility.

The first reason not to provide CPR as a treatment option is when a resident wishes to decline this treatment option even when it is determined by a qualified medical doctor to be an appropriate option. Similarly, this would include cases where the resident is not competent to decide for him or herself and has previously indicated this position through an advanced health care directive or as verbally articulated by the appointed proxy.

The second reason not to provide CPR as a treatment option is why Saint Vincent’s Nursing Home has determined that we are unable to provide this option to our residents. The majority of our resident population is comprised of the frail elderly and individuals with multiple health concerns.

PURPOSE

The purpose of this policy is to fully disclose to prospective residents and their family members that we are not equipped to routinely offer CPR as a treatment choice to our population.

If successful, the provision of CPR will almost always lead to an admission to an intensive care unit to ensure comprehensive care and monitoring. Many residents in long term care facilities do not desire to be transferred to hospital if their condition deteriorates; but prefer the option of on-site palliative care being provided. Furthermore, the goal of intensive care is to prevent unnecessary suffering and premature death by treating REVERSIBLE illness for an appropriate period of time. The goal of appropriate palliative care is to provide quality end-of-life care.

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PRINCIPLES

Residents have a right to receive quality end-of-life care and we are fully prepared to offer this option to both our present and prospective residents.

We are also prepared to offer our present and prospective residents assistance in the preparation of an advanced health care directive, which will facilitate us to meet their anticipated health care goals at a time when they are no longer able to express their wishes themselves.

Residents have a right to receive life-sustaining treatments that meet the standard of care (defined as care provided by a reasonable health care provider who possesses and exercises the skill, knowledge and judgment of the normal prudent practitioner of his or her special group; Picard and Robertson, Legal Liability of Doctors and Hospitals in Canada, 1996; Weijer, Singer, Workman, CMAJ 159 (1998) 817-821). However, health care providers are not obligated to offer treatments that lie outside of the standard of care if research shows that the outcome of such care outweighs the benefit of providing care. Many health care professionals recognize that CPR is not an effective treatment option for the frail elderly (Gordon, 1993) “Poor Outcome of On-site CPR in a Multi-level Geriatric Facility; Three and a half Years Experience at the Baycrest Centre for Geriatric Care” JAGS 41 (1993) 163-166) and that the majority of admissions into long term care facilities comprise this component of the elderly population.

POLICY STATEMENT

CPR is not a treatment option available at this facility because it is our belief that our population is better served by limited resources being directed to treatment options that better support quality end-of-life issues for our residents, such as palliative care programs. We none the less appreciate that there will be instances when a specific resident, because of personal choice, religious or philosophical beliefs, will request that exceptional effort be initiated to support resuscitation. We will continue to endeavour to meet the needs of these individual residents; and, in the event of a witnessed cardiac arrest, offer basic life support services and concurrently place a call to 911 emergency medical services for transfer to acute care for assessment and treatment. It is the objective of this facility to offer excellent, supportive, quality care for all our residents residing within this facility and to respect the individual choices of our resident population.

RECOGNITION OF ADVANCED DIRECTIVES

This facility recognizes all advanced directives meeting the requirements of the Medical Consent Act of Nova Scotia, and encourages and supports all residents in the completion of these documents that can be used to ensure that the wishes of the resident (in respect to the acceptable limits of treatment) are determined.

COMMUNICATION OF OUR POSITION ON RESUSCITATION

This policy statement will be contained in our admission information package.