RESPECT? Do we have any for our patients?

Introduction 

It is recognised that CPR should be based on an individual risk-benefit assessment, taking into account the likelihood of success, potential harms, and the patient’s wishes. RESPECT forms have been created to document personalised recommendations for emergency care based on discussions around a patient’s preferences, values, and wishes regarding future treatment and end-of-life care . 

This project aimed to assess and improve adherence to guidance from the Resuscitation Council UK regarding DNAR decision-making, patient + NOK discussions and documentation of these decisions with the introduction of RESPECT forms. 

Method

The sample consisted of a 'pre respect' and 'post respect' group of patients who had agreed to a DNAR decision during their current hospital admission. Data collection involved reviewing patient records and documenting responses to a series of audit criteria, primarily in a yes/no format, specifically focusing on discussion with patient, discussion with NOK, countersignature by consultant and completion when patient in a stable condition. 

Results 

Pre-respect’ data revealed 58% of DNAR decisions were discussed directly with patients and 44% with next of kin (NOK). This improved ‘post-respect’, 86% discussed with patients and 64% with NOK.

The proportion of DNAR decisions made while patients were clinically stable also increased from 79% to 91%.

Consultant countersignature rates remained similar between cycles (82% vs 81%)

Conclusions 

Overall, this QIP demonstrated an improved adherence to best practice in DNAR decision-making following the implementation of RESPECT forms. 

The main area for improvement is communication with patients’ next of kin (NOK). Resuscitation Council guidelines recommend discussing DNAR decisions with patients and those close to them at the earliest opportunity. Documentation of discussions with patients and/or NOK on PPM should also be completed consistently whenever a CPR-related decision is made.