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Resuscitation notices and COVID-19: RCN backs review of DNACPR use

Care Quality Commission to review notice use during pandemic, after concerns about consent

Care Quality Commission to review notice use during pandemic, after concerns about consent

Picture: iStock

The RCN has backed an investigation into how do not attempt cardiopulmonary resuscitation (DNACPR) notices have been used during the coronavirus pandemic.

The government asked the Care Quality Commission (CQC) to carry out a review of how such notices had been applied, after the CQC raised concerns that older and vulnerable people may have had DNACPR decisions made without their consent, or may have made them without enough details for an informed decision.

Decision to not attempt resuscitation should never be an order

The CQC says plans for the review are still being put into place, but it expects that peoples experiences in care homes, primary

Care Quality Commission to review notice use during pandemic, after concerns about consent

An older person's hands, one with a DNACPR band around the wrist
Picture: iStock

The RCN has backed an investigation into how do not attempt cardiopulmonary resuscitation (DNACPR) notices have been used during the coronavirus pandemic.

The government asked the Care Quality Commission (CQC) to carry out a review of how such notices had been applied, after the CQC raised concerns that older and vulnerable people may have had DNACPR decisions made without their consent, or may have made them without enough details for an informed decision.

Decision to not attempt resuscitation ‘should never be an order’

The CQC says plans for the review are still being put into place, but it expects that people’s experiences in care homes, primary care and hospitals will be investigated.

RCN director of nursing, policy and public affairs Susan Masters
RCN director of nursing, policy and
public affairs Susan Masters

RCN director of nursing, policy and public affairs Susan Masters said: ‘The RCN has always been clear that the term DNACPR order is both misleading and problematic – the decision to not attempt resuscitation should never be an order, and blanket decisions are never acceptable.’

Ms Masters said such decisions should be part of a care plan, with input from the individuals concerned and their families.

‘While the review is yet to begin, we share the view of the need for clarity in any decisions that are taken around emergency and end of life care,’ she said.

Review aims to identify where decisions may not have been patient-centred

The CQC, along with the British Medical Association, the Care Provider Alliance and the Royal College of General Practitioners, sent a joint statement on the importance of advance care planning to social care providers and GP practices in March.

The statement said: ‘It is unacceptable for advance care plans, with or without DNAR form completion, to be applied to groups of people of any description. These decisions must continue to be made on an individual basis according to need.’

CQC chief inspector of primary medical services and integrated care Rosie Benneyworth said: ‘Through this review we will look to identify and share best practice in this complex area, as well as identifying where decisions may not have been patient-centred and ensuring mistakes are not repeated.’

The CQC will report its interim findings later this year, with a final report in early 2021.


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