A No CPR Bracelet in Your Consult: What Now?
When you notice a No CPR identifier, what happens next matters, ethically and professionally.
In clinical practice, regulated health care practitioners share a responsibility to recognize, respect, and accurately document No Cardiopulmonary Resuscitation (No CPR) Orders. These are not just forms. They represent a patient’s values, wishes, and right to make decisions about their own care.
For some patients, particularly those nearing the natural end of life or living with a life-limiting or life-threatening illness, choosing not to receive CPR or other emergency resuscitative measures is a deliberate and deeply personal decision. In British Columbia, the No CPR form provides a clear complying pathway for patients to document this choice with their medical doctor or nurse practitioner.
For a No CPR Order to be valid, it must be signed by:
- A consenting adult patient, or their legally authorized substitute decision maker, and
- The patient’s medical doctor or nurse practitioner
Once in place, this order must be recognized by health care practitioners and first responders.
The Compliance and Ethical Foundation
At the core of No CPR Orders is patient autonomy. Competent adults have the legal right to refuse medical treatment (as per the Health Care (Consent) and Care Facility (Admission) Act (RSBC 1996, c. 181). When a patient lacks capacity, that decision may be made by a substitute decision maker, such as a representative named in a Representation Agreement.
It is important to be clear about what a No CPR Order does and does not mean. “No cardiopulmonary resuscitation” means that CPR will not be initiated in the event of cardiac or respiratory arrest.
It does not mean that care stops.
Patients with a No CPR Order may still receive:
- Pain and symptom management
- Antibiotics
- Dialysis
- Nutritional support
Avoiding assumptions at this point in time is critical.
Your Professional Responsibilities
When you encounter a patient with a No CPR Order, your role as a health care practitioner includes:
- Honouring patient autonomy by respecting their stated wishes
- Providing equitable care, including comfort, supportive, and palliative care
- Avoiding assumptions about what treatments a patient does or does not want
- Facilitating informed conversations with patients and families about goals of care
How health care practitioners respond in these moments builds trust and ensures care aligns with what matters most to the patient.
Acknowledging and Documenting a No CPR Order
When you identify a No CPR Order, consider the following steps:
- Verify the order
Confirm that the form is current and signed by an authorized provider. Official identifiers, such as bracelets or wallet cards, are valid indicators.
- Document thoroughly
Clearly record the No CPR status in the patient’s health care record. Document relevant discussions, updates, and any changes. If there are specific instructionsregarding actions at the time of death, such as who to notify or whether emergency services should be contacted, include those details.
- Communicate clearly
Ensure that all relevant members of thehealth care team are aware of the No CPR status. Use clear, unambiguous language to prevent misunderstandings, especially during transitions of care.
If a Patient Changes Their Mind
Patients can revoke a No CPR Order at any time. This may be done verbally, by destroying the form, or by removing identifying items such as a bracelet. If a revocation occurs, it is essential to notify the health care team immediately and remove the No CPR Order from the patient’s health care record.
Upholding No CPR Orders is a fundamental part of person-centred, ethical practice. It requires attentiveness, clear communication, and careful documentation. When we handle these moments well, we honour not only legal obligations, but also the trust patients place in us as health care professionals.
For more information, visit HealthLink BC – No CPR Form.
