Determining the educational needs of healthcare professionals in communicating the Recommended Summary Plan for Emergency Care and Treatment

Introduction:

The Care of the Elderly/Frailty team at UHCW sought to improve practice in the application of the Recommended Summary Plan for Emergency Care and Treatment plan (ReSPECT A rapid review of the evidence was undertaken, focusing on a broad review question: what are the educational needs of healthcare professionals regarding the optimal communication and understanding of ReSPECT needs with patients and other healthcare colleagues?

Methods:

A multi-professional Critically Appraised Topic group (CAT) with 6 clinicians from the frailty team at UHCW was established engaging appropriate expertise. The review question and search strategy was agreed; a systemised search of PubMed and Embase databases was undertaken. The results were deduplicated and then each screened by 2 reviewers for eligibility. A third reviewer was used for final adjudication. Each article was quality (blinded) and critically appraised. The review was complete in 7 months, with rapidity achieved through the group.

Results

52 papers were located, with ten papers included. Papers spanned UK, Taiwan (x3); USA (x4); Australia (x1); and Iran (x1). Nine papers were single centre studies, with all cross sectional.

Strengths and Limitations

Bias potential through preference in sampling was mitigated through two reviewers (blinded) and adjudication using third reviewer. This made it impossible to extrapolate data appertaining individual staff groups, such as nurses.

Discussion and Conclusion

Key themes identified are communication and decision making, which broadly relate to the ReSPECT planning process.

· Improved communication with patients required active listening and a holistic approach for each patient to include family/relatives.

· Improved documentation of written and conveyance of verbal communication, improves the plan.

· To actively participate in decision making, nurses would benefit from further education in making active resuscitation decisions.

· Greater awareness is needed of ‘older age patient with multiple conditions’ regarding the influence of these factors, on the decisions of clinicians, regarding inclusion for resuscitation.

Each are interconnected to the quality of the plan and confidence of staff to participate in the ReSPECT process and may require some training and modification of documentation.