Talking through resuscitating a patient when in hospital
For the few of you that may not be aware when you are admitted to hospital suffering from some life threatening condition, disease or illness, your treating doctor may well have a discussion with you, or if you are not capable a member of your family, about the wisdom or otherwise of attempting to resuscitate you if you suffer a cardiopulmonary collapse i.e. effectively your heart stops.
Contrary to some populist dramas your chances of being resuscitated unscathed are quite low. The chances of the attempted resuscitation causing you some harm, albeit perhaps limited to, for example, fractured ribs, are quite high.
You can understand in current circumstances why such discussions may have become more frequent. However, it transpires, worryingly, that in fact with certain groups of the population these discussions may not have increased during the pandemic.
On December 3, the Care Quality Commission published an interim report of a review into the application of such decisions during the pandemic. It was noted that guidance intended to help clinicians assess frailty when considering the appropriateness of critical care had been initially interpreted as the sole basis for a DNACPR decision in some cases.
This was apparently quickly acknowledged and changed. The CQC did hear some evidence that earlyinthepandemicpatientsand their relatives received DNACPR decisions that were not based on their wishes and needs and even without their knowledge or consent. There was some concern that the issue may have affected somegroupsmorethanotherse.g. those with learning disabilities and the elderly. Further research is being carried out in seven areas and a final report is due early next year. There is one concern that the report highlighted that cannot wait for the final review.
Apparently, some of these inappropriate DNACPR orders may remain in place. The CQC reminded care providers to ensure that decisions had been made appropriately, in discussion with the patient and in line with legal requirements. Although it may not be at the front of most relative’s minds when their loved one is admitted to hospital in current circumstances it would appear that regrettably they would be well advised to ensure that appropriate discussions have taken place with their family member or themselves before a DNACPR order is signed.