‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) notices are used with the intention of protecting people from an invasive intervention that they would not benefit from or would prefer not to have.
University of Cambridge collaborative research has identified many problems with the use and interpretation of DNACPR notices in practice, and has helped develop and evaluate a new patient-centred approach – the ReSPECT process – to empower patients to make personalised decisions about their goals of care and preferences for resuscitation.
Supported by the Resuscitation Council UK, and endorsed by the Royal College of Physicians, Faculty of Intensive Care Medicine and other major bodies, ReSPECT has replaced the system of DNACPR notices across much of the National Health Service (NHS).
It ensures that emergency decisions reflect patients’ priorities and it improves conversations around anticipatory care planning by placing the focus on establishing shared understanding about goals of care. It supports clinicians in emergency situations, and it reduces harms.
ReSPECT is valued by patients and staff for its patient-centred focus and clarity about goals of care. It was referenced as an example of good practice in the recent Care Quality Commission report: Protect, Respect, Connect. Its positive impacts for the NHS include reduced readmissions to hospital, with associated cost-savings.
“The research in Cambridge has directly contributed to an overall change in approach to, and discussion and documentation of, resuscitation decisions: this has made it easier for ambulance clinicians to deliver excellent and appropriate care for patients.”– Dr Dhushy Kumar, recent chair of the Joint Royal Colleges Ambulance Liaison Committee