A Quality Improvement Project on improving implementation of ReSPECT forms in Community Care Beds

Background

ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) forms are used nationally to record advanced care planning (ACP) and resuscitation decisions. The Community Care Beds (CCBs) in Leeds offer inpatient rehabilitation to older patients including a comprehensive geriatric assessment, ACP and a resuscitation discussion which is recorded on a ReSPECT form.

Objective

To increase the number of patients in CCB beds who have a ReSPECT form in place.

Methods

The medical notes of patients in 4 CCBs in Leeds on a single day were reviewed for the presence of a ReSPECT form. Following an intervention, this was repeated and results were compared.

Intervention

A ReSPECT section was added to the clerking proforma for patients admitted to CCBs to prompt discussion.

ReSPECT form status was reviewed during weekly multi-disciplinary team meetings.

Results

115 and 109 patients respectively were analysed during the first and second cycle. Post intervention there was a small increase in the number of ReSPECT forms placed at the CCB, 12.2 to 16.5%, however there remained little difference in the total numbers who had ReSPECT forms from 83.5% to 84.4%.

Conclusion

The interventions we put in place made a small positive difference to the number of forms completed at the CCBs. We have identified possible reasons why the total numbers of forms completed in the two groups were similar which will help inform work on this area in the future.  These included issues with different or no documentation completed, patients needing time to consider or discuss the decision with family and some had not been seen by a doctor.

We have found that in the CCBs and after a hospital admission, is an effective time to have ACP and resuscitation discussions with patients as part of their comprehensive geriatric assessment and this conversation is usually well received.