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Discussion and reasons behind decisions taken, as well as the information given to the patient and relatives, should be clearly recorded.^230,231

Hospitals should have pathways to alleviate pain and suffering, which should be individualised to the needs of the patient and discussed with their relatives or supporters.²³²

Hospitals should have local guidelines for when a patient dies in theatre or soon after in recovery.  This should include arrangements to maintain dignity for the patient and to give relatives the best support possible. It should also include arrangements to minimise the impact on other patients being treated in the theatre complex.⁶⁰

Hospitals should offer the same level of access for discussion and explanation to relatives of patients who die in the theatre complex, or don't undergo surgery, as those who die in critical care. 

Where end of life care is instituted, this should be in accordance with national and local guidance and audited for quality in the same way that surgical care is audited.²³³

Hospitals should have a DNACPR guidance and documentation that complies with national requirements.^96,231

Patients who may require surgical procedures with DNACPR decisions in place should have senior members of the anaesthetic and surgical team review the condition of the patient and the DNACPR status. Where feasible, a discussion should take place with the patient and their next of kin and it may be appropriate to suspend components of a DNACPR decision (e.g. tracheal...

Organisations should provide up to date, reliable information resources for patients and their relatives e.g. based on literature available from the Royal College of Anaesthetists and Association of Anaesthetists.²¹⁹ It should include information about the process they will experience, and what their postoperative care will mean for them.^220,221

As part of a quality improvement programme, hospitals should develop a local understanding of the adequacy of their consent process and information supplied to patients undergoing emergency surgery, by proactively seeking patient feedback and allocating appropriate resources to this process.²⁰⁷

Organisations should have clear guidance, policies and training for all staff taking consent, which is in accordance with GMC guidance. Anaesthetists must work in partnership with patients and other healthcare professionals, to ensure good care guided by the principles listed next.²²²

• Healthcare professionals should assume patients have capacity to make decisions until assessed and proven otherwise. Clinicians should...