Blanket orders not to resuscitate some care home residents at the start of the Covid pandemic have been identified in a report by England’s care regulator.
A report published by the Care Quality Commission (CQC) found disturbing variations in people’s experiences of do not attempt cardiopulmonary resuscitation (DNACPR) decisions during the pandemic.
Best practice is for proper discussions to be held with the person involved and/or their relatives. While examples of good practice were identified, some people were not properly involved in decisions or were unaware that such an important decision about their care had been made. Poor record-keeping, and a lack of oversight and scrutiny of the decisions being made, was identified.
The report, Protect, respect, connect – decisions about living and dying well during Covid-19, calls for a ministerial oversight group – working with partners in health and social care, local government and the voluntary sector – to take responsibility for delivering improvements in this area.
The report surveyed a range of individuals and organisations, including care providers and members of the public, and identified:
Serious concerns about breaches of some individuals’ human rights
Significant increase in DNACPRs put in place in care homes at the beginning of the pandemic, from 16,876 to 26,555
119 adult social care providers felt they had been subjected to blanket DNACPR decisions since the start of the pandemic
A GP sent DNACPR letters to care homes asking them to put blanket DNACPRs in place
In one care home a blanket DNACPR was applied to everyone over 80 with dementia
Healthcare professionals emphasise that resuscitation is both invasive and traumatic with only a 15-20% survival rate when performed in hospitals and a 5-10% success rate when performed outside hospitals.
However, concerns have been raised about both blanket DNACPR orders being put in place and such instructions being recorded on patients’ records without discussion or informed consent being given.
Eleanor Sturge lost her 62-year-old husband, who was in a care home following a stroke, to Covid last March. She was notified without any prior discussion that a blanket DNACPR was being placed on people in the care home. A letter from the GP stated: “Dear [care home resident relative]” and added that after looking at the medical notes and using a computer algorithm: “I realise there is less than one per cent chance of resuscitation being successful. For this reason I have signed a do not resuscitate order in their nursing notes.”
The Department of Health and Social Care asked CQC to conduct a rapid review of how DNACPR decisions were used during the coronavirus pandemic, building on concerns that they were being inappropriately applied to groups of people without their knowledge.
Rosie Benneyworth, the chief inspector of primary medical services and integrated care at the Care Quality Commission, said: “Personalised and compassionate advance care planning, including DNACPR decisions, is a vital part of good quality care. Done properly, it can offer reassurance and comfort for people and their loves ones – before and during difficult times. It is vital we get this right and ensure better end-of-life care as a whole health and social care system, with health and social care providers, local government and the voluntary sector working together.”