RCUK is pleased to endorse the Association of Anaesthetists clinical practice guideline for implementing advance care plans in the peri-operative period, including plans for cardiopulmonary resuscitation.
The consensus document, published on 15 February 2022, is essential reading for surgeons and anaesthetists, as it provides guidance on conversations, goal setting and recommendations peri-operatively.
It summarises the legal framework around attempting CPR peri-operatively and provides guidance on how and when to instigate conversations between patients and clinicians about valued outcomes.
The guidance includes 6 recommendations:
- Organisations should provide mandatory training relating to their advance care planning and resuscitation policies and documents.
- Organisations should put in place processes to ensure that healthcare teams are aware of the existence and content of any advance decision to refuse treatment made by a patient.
- Clinicians should have an early discussion with a patient pre-operatively to ensure a shared understanding about which peri-operative treatments – including cardiopulmonary resuscitation (CPR) – would be appropriate and desired.
- It is usually appropriate to suspend a DNACPR recommendation during the peri-operative period.
- If an anaesthetist believes they cannot facilitate a successful patient-centred outcome which satisfies the patient’s wishes, further senior opinions should be sought.
- All clinicians should consider making themselves familiar with newer processes and documents which are increasingly replacing stand-alone DNACPR forms.
RCUK’s ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) sub-committee Chair Dr Zoe Fritz and sub-committee member, retired Consultant, David Pitcher, were involved in the development of the Guideline.
Dr Zoe Fritz said:
“We thank the Association of Anaesthetists for involving RCUK in the development of this Guidance and welcome their clear recommendations for anaesthetists implementing advance care plans in the peri-operative period.
“It is pleasing to see a recognition of changing practice away from DNACPR forms to processes, such as ReSPECT, that involve broader conversations about what matters to a person and contextualise CPR decision-making within overall care and treatment goals. Anaesthetists and surgeons should work together with patients prior to surgery to develop a shared understanding of possible outcomes, and define what the patient would want in the event of a post operative complication that requires intensive care. The guidance also provides clarity that it is usually appropriate to temporarily suspend a recommendation not to attempt CPR in the in the peri-operative period, and the importance of discussing and agreeing this with the patient and explaining it to the wider healthcare team.”