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=== Covid-19 ===
=== Covid-19 ===
In 2020 it emerged that blanket DNACPR orders had been applied to UK care home residents during the Covid-19 pandemic,<ref name="Booth 2020">{{cite news |last1=Booth |first1=R |title=Inquiry begins into blanket use in England of Covid 'do not resuscitate' orders |url=https://www.theguardian.com/world/2020/oct/12/inquiry-begins-into-blanket-use-in-england-of-covid-do-not-resuscitate-orders |access-date=3 March 2021 |work=The Guardian |date=12 Oct 2020}}</ref> leading to concerns people’s individual circumstances had not been assessed and the person concerned was not involved in the decision making.<ref name="CQC 2020">{{cite journal |last1=Care Quality Commission |title=Review of Do Not Attempt Cardiopulmonary Resuscitation decisions during the COVID-19 pandemic: Interim report November 2020 |date=2020 |url=https://www.cqc.org.uk/sites/default/files/20201204%20DNACPR%20Interim%20Report%20-%20FINAL.pdf}}</ref> These blanket orders are currently being investigated by the [[Care_Quality_Commission |Care Quality Commission]], who cited ReSPECT as one the best practice approaches in their interim report,<ref name="CQC 2020" /> because having conversations to understand patients’ wishes about resuscitation is particularly important in the pandemic.<ref name="Jevon 2020">{{cite journal |last1=Jevon |first1=P |title=How to ensure safe and effective resuscitation for patients with Covid-19 |journal=The Nursing Times [online] |date=2020 |volume=116 |issue=7 |pages=26–30 |url=https://www.nursingtimes.net/clinical-archive/infection-control/how-to-ensure-safe-and-effective-resuscitation-for-patients-with-covid-19-22-06-2020/}}</ref>
In 2020 it emerged that blanket DNACPR orders had been applied to UK care home residents during the Covid-19 pandemic,<ref name="Booth 2020">{{cite news |last1=Booth |first1=R |title=Inquiry begins into blanket use in England of Covid 'do not resuscitate' orders |url=https://www.theguardian.com/world/2020/oct/12/inquiry-begins-into-blanket-use-in-england-of-covid-do-not-resuscitate-orders |access-date=3 March 2021 |work=The Guardian |date=12 Oct 2020}}</ref> leading to concerns people’s individual circumstances had not been assessed and the person concerned was not involved in the decision making.<ref name="CQC 2020">{{cite journal |last1=Care Quality Commission |title=Review of Do Not Attempt Cardiopulmonary Resuscitation decisions during the COVID-19 pandemic: Interim report November 2020 |date=2020 |url=https://www.cqc.org.uk/sites/default/files/20201204%20DNACPR%20Interim%20Report%20-%20FINAL.pdf}}</ref> These blanket orders are currently being investigated by the [[Care_Quality_Commission |Care Quality Commission]], who cited ReSPECT as one of the best practice approaches in their interim report,<ref name="CQC 2020" /> because having conversations to understand patients’ wishes about resuscitation is particularly important in the pandemic.<ref name="Jevon 2020">{{cite journal |last1=Jevon |first1=P |title=How to ensure safe and effective resuscitation for patients with Covid-19 |journal=The Nursing Times [online] |date=2020 |volume=116 |issue=7 |pages=26–30 |url=https://www.nursingtimes.net/clinical-archive/infection-control/how-to-ensure-safe-and-effective-resuscitation-for-patients-with-covid-19-22-06-2020/}}</ref>


== Evaluation ==
== Evaluation ==

Revision as of 12:37, 6 March 2021

ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. It is an emergency care and treatment plan (ECTP) in which personalised recommendations for future emergency clinical care and treatment are created through discussion between health care professionals and a person (or their legal proxy or those close to them).[1] These recommendations are then documented on a ReSPECT form.[2]
The ReSPECT process is centred around conversations which aim to develop a shared understanding between the healthcare professional and a person about their condition, the outcomes the person values and those they fear[3] and then how treatments and interventions, such as cardiopulmonary resuscitation (CPR) fit into this.[4] It supports the important principle of personalised care,[5] moving away from a yes/no CPR decision to one that is more nuanced and patient centred.[6]
A person’s ReSPECT form includes recommendations about emergency treatments that could be helpful and should be considered, as well as those not wanted by or that would not work for them.[4] It includes a recommendation about cardiopulmonary resuscitation (CPR), but that may be a recommendation that CPR is attempted, or a recommendation that it is not attempted.[7]
ReSPECT forms are not legally binding but can be used by health care professionals to guide them when providing treatment for the person in a future emergency situation.[8] As the ReSPECT process and form are designed to be recognised across different care settings (for example between hospitals, primary care, ambulance services, or care homes) and to cross geographical boundaries, the person does not have to undertake repeated conversations and discussions.[8]

Development

ReSPECT was developed after attendees at a 2014 summit at the Royal Society of Medicine on Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions in the UK criticised the variability and problematic practice linked to standalone DNACPR decisions.[9] The UK Government supported the development of the ReSPECT process after the Health Select Committee recommended that the use of DNACPR orders should be reviewed.[10] Development of the ReSPECT process involved a review of literature, a national consultation, interviews with healthcare professionals and members of the public, a workshop with patients and public, and a usability trial.

Usage

The ReSPECT process is used in around 70% of counties in England and in some areas of Scotland. In the UK, 21% of hospitals had adopted ReSPECT by December 2019.[11] ReSPECT is the fastest growing ECTP in the UK, as many hospitals move away from using standalone DNACPR forms.[11]

Covid-19

In 2020 it emerged that blanket DNACPR orders had been applied to UK care home residents during the Covid-19 pandemic,[12] leading to concerns people’s individual circumstances had not been assessed and the person concerned was not involved in the decision making.[13] These blanket orders are currently being investigated by the Care Quality Commission, who cited ReSPECT as one of the best practice approaches in their interim report,[13] because having conversations to understand patients’ wishes about resuscitation is particularly important in the pandemic.[14]

Evaluation

An evaluation of the use of ReSPECT[11] in hospitals in England, during the early stages of adoption found the following:

  • Hospital-based healthcare professionals prioritised ReSPECT conversations with patients whom they identified as terminally ill or anticipated were at imminent risk of deterioration. A move towards a more holistic approach in terms of treatment recommendations and conversations was observed. However, a central component of many conversations focused on situations where CPR attempts were not recommended.
  • Emergency care treatment planning conversations are often complex and need to draw together patients' preferences and values within a framework of clinical judgement.
  • Conversations were easier for patients, their family, and health care professionals if patients had thought about these things in advance and discussed this with their family.
  • Patients (and / or those close the patient) were involved in making most but not all emergency care treatment plans. The ReSPECT supporting materials were rarely used during decision making. Involvement of patients usually focused on asking about their preferences for specific treatments or explaining recommendations. It was rarer for patients to be asked about their values and preferences, and for these to influence recommendations.[15]
  • Recommendations on ReSPECT forms completed in hospital sometimes are not helpful when future decisions are made in the community.
  • ReSPECT conversations take time to do properly and so may not happen or be done well if there is limited time because of staff shortages or a busy ward environment.

References

  1. ^ Pitcher, D (2017). "Emergency care and resuscitation plans". BMJ. 356: j876. doi:10.1136/bmj.j876. PMID 28246080. S2CID 27776324.
  2. ^ Resuscitation Council UK. "ReSPECT for Patients and Carers". Retrieved 30 January 2021.
  3. ^ Compassion in Dying (14 March 2017). "The new ReSPECT process". Retrieved 3 March 2021.
  4. ^ a b Fritz, Z (2017). "Resuscitation policy should focus on the patient, not the decision". BMJ. 356: j813. doi:10.1136/bmj.j813. PMC 5330195. PMID 28246084.
  5. ^ Resuscitation Council UK. "The ReSPECT Process: For Health and Care Professionals 2020". Retrieved 11 June 2020.
  6. ^ Oliver, D (2020). "Detoxifying DNACPR decisions". BMJ. 371: m4069. doi:10.1136/bmj.m4069. PMID 33115785. S2CID 225078100.
  7. ^ Ford, M (16 September 2020). "Emergency care forms tweaked to make them more 'patient-centred'". Nursing Times. Retrieved 3 March 2021.
  8. ^ a b Fritz, Z (2017). "ReSPECT is a personal emergency care plan summary". BMJ. 357: j2213. doi:10.1136/bmj.j2213. PMID 28487394. S2CID 38981725.
  9. ^ Hawkes, C (2020). "Development of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT)" (PDF). Resuscitation. 148: 98–107. doi:10.1016/j.resuscitation.2020.01.003. PMID 31945422.
  10. ^ Department of Health. "Department of Health Government Response to the House of Commons Health Select Committee Report on End of Life Care (Fifth Report of Session 2014-15)". Gov.uk. Retrieved 3 March 2021.
  11. ^ a b c Perkins, GD (2021). "Evaluation of the Recommended Summary Plan for Emergency Care and Treatment". Health Services and Delivery Research.
  12. ^ Booth, R (12 Oct 2020). "Inquiry begins into blanket use in England of Covid 'do not resuscitate' orders". The Guardian. Retrieved 3 March 2021.
  13. ^ a b Care Quality Commission (2020). "Review of Do Not Attempt Cardiopulmonary Resuscitation decisions during the COVID-19 pandemic: Interim report November 2020" (PDF). {{cite journal}}: Cite journal requires |journal= (help)
  14. ^ Jevon, P (2020). "How to ensure safe and effective resuscitation for patients with Covid-19". The Nursing Times [online]. 116 (7): 26–30.
  15. ^ Eli, K (2021). "Why, when and how do secondary-care clinicians have emergency care and treatment planning conversations? Qualitative findings from the ReSPECT Evaluation study". Resuscitation. doi:10.1016/j.resuscitation.2021.01.013. PMID 33482270.


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