Support and training needed to help clinicians with DNACPR decisions, says CQC

Clinicians need more support and training to ensure Do Not Attempt CPR (DNACPR) decisions are made in a clear and consistent way across the NHS, the CQC has warned.

CQC chief inspector of primary care Dr Rosie Benneyworth
CQC chief inspector of primary care Dr Rosie Benneyworth

The Protect, respect, connect – decisions about living and dying well during COVID-19 report concluded that health staff needed the ‘knowledge, skills and confidence’ to speak with people about, and support them in, making DNACPR decisions.

It said that the pandemic had created ‘additional challenges’ for clinicians to have conversations with patients ‘under pressure and often during emergency situations’.

The watchdog argued that there needed to be a consistent approach in the language used and the way advance care planning and DNACPR decisions are talked about.

DNACPR decisions

It has recommended that a ministerial oversight group should be established to scrutinise the issues raised in the report and oversee the required changes.

The government commissioned the CQC to carry out a review of DNACPR decisions last October following concerns that they were being applied inappropriately during the pandemic.

The report found that 6% of the 2,048 adult social care services that responded to its information request felt that people in their care had been subject to 'blanket' DNACPR decisions since 17 March 2020.

It also revealed that 3.8% of 9,679 DNACPR decisions put in place since 17 March last year had not been considered as part of a personalised care plan - and found that human rights were potentially breached in more than 500 cases.

Patient care

Chief inspector of primary medical services at the CQC Dr Rosie Benneyworth, 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 loved 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.

BMA medical ethics committee chiar Dr John Chisholm said it was ‘a tragedy and unacceptable’ that poor DNACPR notices may have caused avoidable deaths. ‘We hope that the publication of this report begins to challenge any local level issues which have occurred, and that swift action is taken to ensure consistently high standards of practice,’ he said.

‘Discussions about whether or not patients would want CPR to be attempted should be one part of individualised advance care planning, and be open to scrutiny and happen with proper oversight as today’s report suggests. DNACPR decisions should never be made on the basis of a blanket approach applied to all.'

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