We welcome the Care Quality Commission’s Interim Report of its Review of Do Not Attempt Cardiopulmonary Resuscitation decisions during the COVID-19 pandemic.
We agree with CQC’s stance that “conversations about DNACPR should not happen in isolation.” In its interim report, CQC states “we expect DNACPR decisions to take place as part of broader conversations about future care and treatment.”
Working with healthcare professionals, patients and their families, Resuscitation Council UK has worked hard over recent years to develop the ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) process. The process supports conversations about care in a future emergency. ReSPECT is already being used by communities in 70% of counties in England and we are pleased to see the CQC’s inclusion of the ReSPECT process in the ‘Best practice approaches in advance care planning’ section of their interim report.
The report states:
“The ReSPECT process creates personalised recommendations for a person’s clinical care and treatment in a future emergency in which they are unable to make or express choices. These recommendations are created through conversations between a person, their families, and their health and care professionals to understand what matters to them and what is realistic in terms of their care and treatment.
“The scope extends far beyond decisions around DNACPR and, if used effectively, should ensure that any decisions about CPR are achieved through a well-structured and person-centred conversation between healthcare professionals and the person about their care and what matters to them. Decisions about emergency treatments, such as CPR, should fit within a shared understanding of the person’s condition and preferences. The resulting clinical recommendations are much broader and can include whether or not a person is to be taken to hospital, admitted to critical care or placed on a ventilator. These recommendations are recorded on a ReSPECT form. In addition it records a recommendation about starting CPR, or not.”
We appreciate this is an interim report and that CQC has further work to carry out as part of its review, before publishing its final report. Nevertheless, we hope that by CQC recognising ReSPECT as a tool that can aid individualised discussions and planning, more health and social care organisations will act now to adopt the ReSPECT process in their area. We look forward to CQC defining good practice and setting out clear recommendations early next year, as patients should get good quality, personalised care wherever they live.
To find out more about ReSPECT, visit: https://www.resus.org.uk/respect