We recently conducted an audit of the documentation of cardiopulmonary resuscitation (CPR) status in patients on a 20-bed dementia assessment ward (all with a diagnosis of dementia and lacking mental capacity to discuss resuscitation) and found that only a quarter had their CPR status documented. Following discussions with staff to draw their attention to trust policy on CPR, re-audit showed only modest improvement: CPR status was documented in half of the patients’ notes. An educational programme was arranged to address the potential barriers to optimal CPR documentation. Subsequent audit showed documentation of CPR status in three-quarters of patients.

Poor quality of life and futility of CPR are often cited as the reasons behind the decision not to resuscitate. Despite the advanced age and diagnosis of dementia in our patients, judgements on patients’ quality of life can be complex and emotive, and the critical factor seemed to be a lack of readiness among staff to initiate discussion of issues surrounding death.

We agree that relatives should be involved in discussions on resuscitation. However, this has to be done with sensitivity so that a decision not to resuscitate does not add to the relatives’ sense of guilt. Often this can be achieved by presenting such decisions as a considered opinion of the team before seeking the relatives’ view.