By Graham Robert Nimmo

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Every effort must be made to ensure the emergency services are not called inappropriately where a patient’s death is expected. PATIENTS WITH A DNAR ORDER BEING TRANSPORTED BY AMBULANCE • The ambulance section of the DNAR form must be completed for any such patient form being transported in Lothian by the Scottish Ambulance Service. • Ambulance control must be informed of the existence of the DNAR order at the time of booking the ambulance. 30 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 WHERE NO DNAR DECISION HAS BEEN MADE AND A PATIENT ARRESTS • The presumption is that staff would attempt to resuscitate a patient in the event of a cardio-pulmonary arrest.

It is the main method of communication with the GP as well as being a summary for the case records. Discharge summaries must include: • The main diagnosis for that admission. • Any important concurrent diagnoses. g. living alone. g. central venous lines, endoscopy. • Drugs on discharge including dietary advice. i Highlight any changes to treatment. g. Home Help, District Nurse etc. • Follow-up: arrangements at hospital or with GP. • Information given/not given to patient and relatives. How to do it • Text should be relatively brief and detail changes in treatment and adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 39 review arrangements.

Using guidelines, prescribe analgesia as appropriate for the patient. Review. 0 Lothian Guidelines Cancer-related pain: Acute pain Initiate Edinburgh Pain Assessment Tool (EPAT©) for pain score of 4 or above. Use Palliative Care Guidelines. Use Acute Pain Guidelines. PERSISTENT MODERATE OR SEVERE PAIN, WHICH DISTRESSES PATIENT: REFER. SEE FLOW CHART OVER. © Quality Improvement Scotland (QIS) Illness Severity Criteria Subgroup, February 2005. adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 51 Illness Severity and Diagnosis (Risk of Deterioration) • As the ABCD is secured a specific diagnosis is sought with the ‘Targeted Examination’ and specific treatment can then be instituted.

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