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Nurses felt unable to challenge DNACPR decisions, regulator finds

CQC says some lacked confidence to confront doctors over decisions in COVID-19 first wave
Picture shows a medic wearing  face mask and filling in a form on a clipboardv

CQC report says some lacked confidence to confront senior doctors over decisions in COVID-19 first wave

Some nursing staff felt unable to challenge resuscitation notice decisions by senior doctors during the first wave of the COVID-19 pandemic last year, the care regulator says in a report .

Health and social care professionals thought some colleagues lacked the confidence or did not have sufficient knowledge to challenge decisions, the Care Quality Commission (CQC) said in its final report into how do not attempt cardiopulmonary resuscitation (DNACPR) notices were used at the start of the pandemic.

Some staff didnt know enough about the DNACPR process

CQC report says some lacked confidence to confront senior doctors over decisions in COVID-19 first wave

Picture shows a medic wearing  face mask and filling in a form on a clipboard
Picture: iStock

Some nursing staff felt unable to challenge resuscitation notice decisions by senior doctors during the first wave of the COVID-19 pandemic last year, the care regulator says in a report.

Health and social care professionals thought some colleagues ‘lacked the confidence’ or did not have sufficient knowledge to challenge decisions, the Care Quality Commission (CQC) said in its final report into how do not attempt cardiopulmonary resuscitation (DNACPR) notices were used at the start of the pandemic.

Some staff ‘didn’t know enough about the DNACPR process’

The CQC was asked by the Department of Health and Social Care to conduct a review amid concerns that decisions were being made without the involvement of patients or relatives and applied in a blanket way to particular groups, especially older people and those with learning disabilities.

At the height of the first wave in April 2020, the Nursing and Midwifery Council (NMC) and General Medical Council issued a joint statement warning registrants to ensure 'thoughtful and compassionate handling' of discussions about putting a DNACPR notice in place.

The CQC report said: ‘Some health and social care professionals told us that they were worried other professionals lacked the confidence to challenge DNACPR decisions, or they didn’t know enough about the DNACPR process to be able to challenge decisions.

‘Barriers included GPs and care workers not wanting to overturn clinical decisions made in a hospital setting, and nursing staff feeling unable to challenge the decisions of senior doctors.’

Nursing and Midwifery Council executive director of strategy and insight Matthew McClelland
NMC executive director of strategy and insight Matthew McClelland

The CQC found that on 16 March 2020 in England, 74% of nursing home residents (7,009 out of 9,434) reviewed in care homes, primary care and hospital settings had DNACPR notices in place. Between 17 March and December 2020, as more residents went into nursing homes, the number of DNACPR notices increased to 10,647 out of 11,539 residents (92%).

DNACPR training recommended for all health and care professionals

The CQC also noted that a minority of health and social care professionals had issued blanket DNACPR notices at the start of the pandemic, but these were often quickly overturned. The regulator suggested that one of the reasons for inappropriate use of the notices may have been confusion about the guidance.

The CQC report makes a series of recommendations, including training and development being made available for all health and care professionals about DNACPRs. It also calls for health and social care providers to ensure staff understand how to speak up and feel confident to do so in their place of work.

Nursing and Midwifery Council executive director of strategy and insight Matthew McClelland said there needs to be support for professionals to speak up about inappropriate decisions. ‘We all have a responsibility to learn from this report, and to support professionals to speak up about inappropriate decision-making when it happens – together we can all make a difference,’ he said.


Find out more

CQC review of DNACPR decisions during the COVID-19 pandemic


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