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ReSPECT is replacing DNACPR

https://www.resus.org.uk/respect

What is it

  • Recommended Summary Plan for Emergency Care & Treatment
  • A personalised future emergency plan.  One section of the Advanced Care Plan umbrella – specifically focusing on “in the event of an emergency”.

Why ReSPECT?  What was wrong with DNACPR?

  • DNACPR – often negative for patients (because they are not involved), and negative for docs (who don’t like doing it/making decisions on patients without involving them)
  • So, ReSPECT encourages us, health professionals, to INVOLVE the patient – it is there life after all.   And to involve them EARLY rather than late on when they might not be in a state to make decisions.  

In practice, how does it translate?

  • We should be presumptive in favour of patient involvement legally – i.e. just involve them in the decision making.
  • Leaving someone “for CPR” when they may not want it is no less a breach of their human rights
  • Where no explicit decision – there should be an initial presumption in favour of CPR
  • But this DOES NOT mean the indiscriminate application of CPR that will be of no benefit and not in a person’s best interests.

Top tips in applying it

  • Cover what treatment wanted AND what treatment not wanted
  • Do it early – esp those end of life, at risk of cardiac arrest. 
  • Don’t just think the elderly.   It’s for everyone, at any age.
  • Remember, this is about EMERGENCY CARE & TREATMENT
  • Once you have filled in the form…
      • when to review?
      • who keeps it?
      • summarise the document verbally to the patient – i.e. what you have agreed, check understanding, make adjustments if needs be. 

If in doubt, seek the opinion of your medical protection organisation and your local adult/child safeguarding team.  

  • If you would like to have a go at adding some “top tips” to this page for this specialty (and have your name displayed proudly with bradfordvts),  please email me – [email protected]

Some Scenarios

  • What if patient wants resus and as a clinician you feel it is futile
      • Re-open the discussion – you need a deeper conversation. 
      • If you really think it is futile, and the patient still wants it, that usually means you have not explained the pros and cons well enough. 
      • Go back and do more discussion.    This is not about you over-riding their decision, but both of you aligning your viewpoints and shared-decision making.  
  • What if patient’s advocate wants it, and as a clinician you feel not in patient’s best interests
      • Like above, re-open the discussion – you need a deeper conversation. 
      • If you really think it is futile, and the advocate or relative still wants it, that usually means you have not explained the pros and cons well enough. 
      • Go back and do more discussion.   
      • If you feel as a clinician you have done your best to get a conversation going and good explanations – and that it would be futile – but the relatives still wants it – then you may need to get a court order.  Talk to your medical protection organisation first.   It is VERY RARE to have to go down this route.
  • Does the patient’s/patient’s advocate decision override the doctors when they are at variance?
      • No, it doesn’t.  If you think it is futile and not in the patient’s best interests, then that is an important medical decision.
      • HOWEVER, I cannot emphasise enough how you need to go back to having a discussion.   
      • You should not be autocratic or dictatorial when there is a variance of opinions.   The variance signals the need for more discussion. 
      • Deeper and more meaningful discussions usually will help all parties get to the “right” decision.  

Important features in the history

Important features in the Examination

Red Flags

Other Top Tips

Please leave a comment if you have a tip, spot an error, spot something missing or have a suggestion for a web resource.
And of course, if you have developed a resource of your own, please email it to me to share with others.

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