​ ReSPECT Form Completion on Admission to Elderly Care Wards at Huddersfield Royal Infirmary ​ Quality Improvement Project ​

This audit was conducted with an aim to improve the standard and quality of RESPECT forms on elderly care wards ensuring that appropriate advanced care plans for patients are made early and that RESPECT forms are appropriately filled out for patients based on their wishes.  

This audit was conducted by retrospectively reviewing the electronic patient records of 40 patients admitted to the acute elderly care wards at Huddersfield Royal Infirmary from the beginning of May to July 2025.  Patients were selected using a random number generator from admissions during the audit period. Electronic patient records (EPR) were reviewed to assess the completion and documentation of ReSPECT forms during admission.  

The results highlighted that only 37.5% of patients had a RESPECT form available on admission. Admission identified substantial unmet need, with 12 new discussions occurring in patients without an existing form.  Completion rates for DNACPR decisions were high, but person-centred sections such as "What I Most Fear" were completed less frequently.  Seven patients had resuscitation decisions altered without a corresponding RESPECT form, suggesting incomplete documentation of advance care planning and 60% of forms lacked senior countersignature.  Moreover, the audit identified a serious patient safety incident where an existing RESPECT form was not updated electronically, resulting in CPR being performed contrary to documented wishes. 

This audit demonstrates that there are variable areas of improvement in how we, as clinicians, use ReSPECT forms in elderly medicine. While half of patients had a RESPECT form updated or completed during admission. DNACPR documentation rates were high whereas completion of broader patient-centred sections were inconsistent. Significant concerns were identified regarding governance, including lack of senior countersignature, changes in resuscitation status without completion of a RESPECT form, and one serious incident related to failure to update an existing RESPECT decision on the electronic record.