Background The Scottish Government has been instrumental in leading policy development for resuscitation planning. ‘Living and Dying Well’ a national action plan for palliative and end of life care made an integrated approach to DNACPR decision making an action point. This produced the first, national policy for DNACPR decision making in Europe. Simultaneously, work done in the paediatric sector highlighted the need for a positive and permissive approach to resuscitation planning for Children and Young Adults and a parallel government backed initiative produced the Children And Young Peoples Resuscitation Policy which launched in January 2011.

Aims CYPADM aims to prevent unnecessary, unwarranted or unwanted attempts at resuscitation in children. Importantly it goes far beyond a simple cardiopulmonary resuscitation decision as cardiac arrest is a very rare terminal event in children and young adults. It clearly delineates what resuscitative measures are warranted as well as those that are not. It acknowledges that a full resuscitation attempt, including ventilation may be appropriate. CYPADM ensures that discussion of resuscitation of children and young people occurs with consultant medical and senior nursing staff engaging with parents and young people in a developmentally appropriate fashion. CYPADM is intended to be used in all care settings in both the statutory and voluntary sectors.

Method Health Improvement Scotland undertook on-going evaluation of the DNACPR and CYPDM policies in consultation with a core multidisciplinary group including representatives from all Health Boards, the Scottish Ambulance Service, the Care Commission and NHS24. Measures have been developed which will establish the extent to which these policies impact on patient care with regard to inappropriate CPR attempts, expected death, and anticipatory care planning.

Conclusion CYPADM assures an integrated, permissive approach to resuscitation planning and communication for children and young adults across Scotland. Electronic audit via the Scottish Paediatric Surveillance Unit is on-going.