David Pitcher, Working Group co-chair

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Towards a national decision form

• David Pitcher, Working Group co-chair
• Alison Richardson, Working Group member

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Decisions about CPR

•  
• Considering
• Communicating are challenging
• Recording
• Misunderstandings
• Poor decision-making are common
• Communication failures

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NCEPOD in-hospital cardiac arrest2011

• Only 22 had a recorded decision about CPR
  but physiological instability/warning signs in
  73
• Many were elderly, had potentially fatal
  chronic conditions and limited functional
  capacity
• In 196/230 with sufficient data expert advisors
  felt that DNACPR decisions should have been made
• CPR attempted in 52 patients with a DNACPR
  decision and 7 patients on an end-of-life care
  pathway

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Media attention
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...presumption in favour of patient involvement...
...anecdotal reduction in DNACPR decisions...
...but surely leaving someone for CPR when they
may not want it is also a breach of their human
rights...
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October 2014

• there are clear benefits in having (CPR)
  decisions recorded on standard forms that are
  recognised across geographical and organisational
  boundaries within the UK.

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October 2014

• DNACPR
• from best evidence
  to
  best policy and practice

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Review of DNACPR policies practice

• 48 NHS Trusts
• 26 acute
• 12 community
• 10 Ambulance

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DNACPR forms in 48

• RC(UK) form Modified RC(UK)

• Bespoke

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52
17 none sent
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Emergency Care and Treatment Plan (working
title)

• RC(UK), BMA, RCN - facilitate development of a
  national form
• Broad stakeholder and public/patient engagement
• Working group - first met February 2015
• Chairs - David Pitcher RC(UK) JP Nolan RCN
• First draft July 2015 (Personal Emergency Plan)
• Timeline - realistic, pragmatic 1 year (?)

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Health Select Committee March 2015

• we recommend that the government review the
  use of DNACPR orders in acute care settings,
  including whether resuscitation decisions should
  be considered in the context of overall treatment
  plans. This committee believes there is a case
  for standardising the recording mechanisms for
  the NHS in England.

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ECTP should

• be acceptable to - patients
• - those important to them
• - health professionals
• - carers
• - other members of the public
• be underpinned by a good decision-making process
• promote good decision-making
• promote dialogue between individuals and
  clinicians
• be used across all care settings
• be used for individuals of all ages
• use evidence and experience from other successful
  initiatives
• consider decisions about CPR within overall goals
  of care

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Purpose

• To provide immediate guidance to healthcare
  professionals (and others)
• For use when individuals do not have capacity to
  contribute to a decision
• To provide a summary of the anticipatory
  decisions made.
• Not to be a substitute for a more detailed care
  plan.
• For use at all stages of an individuals
  journey or care pathway

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Work in progress...
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Next steps...

• One subgroup working on form design and
  supporting materials
• One subgroup working on consultation, piloting,
  implementation
• Working Group meeting November
• Possible appointment of a project manager

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The way forward...

• One subgroup working on form design and
  supporting materials
• One subgroup working on consultation, piloting,
  implementation
• Working Group meeting November
• Possible appointment of a project manager
• Regard this as a dynamic form/process

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Avoid...
Aim for...

• Confusion
• Conflict
• Chaos

Collaboration Consensus Common sense