‘Do not resuscitate’ orders at care homes investigated
CLAIMS that care homes placed blanket “do not resuscitate” orders on residents at the height of the pandemic are being investigated by the watchdog.
Concerns have been raised that blanket orders were applied to some groups – such as residents in some care homes – in England as the NHS faced the first peak of Covid-19.
The Care Quality Commission said it was examining Do Not Attempt Resuscitation (DNAR) and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders made during the pandemic. Compassion In Dying, a charity, called for an inquiry, saying that since March it had heard several reports of orders being made for patients across a range of healthcare settings in a blanket fashion.
Lord Bethell of Romford, a health minister, announced the investigation in the House of Lords earlier this month.
He said: “The Department is very clear that the blanket use of DNACPR and DNAR is unacceptable. An agreement to a DNACPR is an individual decision and should involve the person concerned or, where the person lacks capacity, their family, carer, guardian or any other legally recognised advocate.”
Dr Rosie Benneyworth, the CQC chief inspector of primary medical services and integrated care, said: “We welcome this commission from the Department of Health and Social Care and are taking it forward at pace. This builds on the concerns we reported earlier in the year and we are pleased that they are being given closer attention.”
Dr Benneyworth added: “Along with partners, we have been clear that 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.”
Health leaders in England wrote to medics on April 7 reminding them that “blanket policies are inappropriate”.
Prof Stephen Powis, the NHS England medical director, and Ruth May, England’s chief nursing officer, wrote: “Blanket policies are inappropriate, whether due to medical condition, disability, or age. This i s particularly important in regard to ‘Do not attempt cardiopulmonary resuscitation’ orders, which should only ever be made on an individual basis and in consultation with the individual or their family.”
It followed a statement from the CQC, the BMA, the Royal College of GPS and the Care Provider Alliance, reminding medics it was “essential” the decisions were made on an individual basis.