An Audit of Quality and Completion of Respect Forms in Southmead Hospital 2025

Introduction

Since 2019, ReSPECT forms have been used to document patient wishes and appropriate escalation of treatment in our hospital. This audit examines the quality and completeness of ReSPECT forms in Southmead Hospital across medical and surgical wards, assessing adherence to national guidance as stipulated by the Resuscitation Council UK. The aim is to identify areas for improvement in documentation practices and issues for future QIPs.

Methods

• This was a retrospective audit done for all inpatient wards in Southmead Hospital
• The acute medical and surgical wards were excluded from the audit, namely 31A&B and 32A&B.
• The data was collected over 2 months from 20th March 2025 to 20th May 2025
• A team of 11 resident doctors, most of them from their respective wards, collected the data on a single day of their choice by reviewing medical notes and assessing notes with ReSPECT forms
• The data was collected and entered into an Excel sheet that was sent to the doctors by the lead in a standard format using all 17 criteria as set by Resus UK, thereby making data analysis simpler
• The Excel sheets were converted into raw numbers and percentages and fed into a table on MS Word.
• This was then used for the graphical representation of the data as well

Results

• The total number of ReSPECT forms assessed in this audit was 295 forms.
• Out of these, 205 were in medical wards and 90 were in surgical wards
• The audit standard is 100% in all criteria
• Modified CPR signature criteria was excluded as out of the total number of patients, only 2 patients were children (stroke ward)
• The option D criteria was also excluded as out of all ReSPECT forms, only 3 of them had option D ticked
• After all exclusions, the audit was done comparing 15 sections of the form
• The best performing criteria were the presence of a signature in the CPR recommendation box and the presence of demographics or a hospital sticker. This was 99.3% (293) in both criteria in Southmead Hospital
• The worst performing criteria was the presence of a mental capacity assessment in notes in case of a lack of mental capacity and reasoning behind the lack of mental capacity. These were 15.2% (11/72) and 48.6% (35/72), respectively, in Southmead Hospital
• 2 ReSPECT forms with missing signatures on the CPR recommendation were in 8B and 28B, each (medical wards)

Conclusion

• High compliance in areas such as demographics, signature of CPR recommendation and form placement in front of notes
• No significant differences in high-performing categories across Southmead, Medical, and Surgical wards
• While surgical wards fared worse in categories like date documented on percentage, the difference is not statistically significant (p=0.12), suggesting random variation due to a smaller sample size
• However, the reasoning of lack of mental capacity CIs between groups did not overlap, and z-tests done show that medical wards performed significantly better than surgical wards at the 95% confidence interval (p <0.05)
• Full MCA documentation in notes when a patient lacks capacity, compliance is universally low
• All wards have very low compliance with legal proxy documentation
• Only 22% compliance with values and fears documentation, suggesting a missed opportunity to reflect patients’ wishes in advanced care planning
• Despite some well-performing criteria, there is a lot of work to be done to reach the standard of 100% in all criteria
• Educational interventions focusing on MCA documentation, legal proxy awareness and capturing patient values
• To send raw data to all ward leads who can extract ward-specific data, which can feed into future QIPs
• Schedule a re-audit within 6-12 months to evaluate the impact of interventions