More than 500 people in the UK have been ordered not to “resuscitate” without their consent or the consent of their carers during the coronavirus pandemic, a Commission for Quality of Care (CQC) study reported on Thursday.
Since the beginning of the COVID-19 pandemic, there have been concerns that “do not attempt cardiopulmonary resuscitation” (DNACPR), decisions have been made without the involvement of individuals, families and / or their carers, if desired, and were applied to groups of people, rather than taking into account the individual circumstances of each person, ”according to the study by the independent health and social care regulator in England.
Of the 2,048 adult social care providers who responded to the CQC’s request for information, 5.2% (508 of 9,679) of the DNACPR decisions taken as of March 17, 2020 “were not agreed in discussions with that person, relative or caregiver. “The study said.
The report includes at least one case study of a man whose death could have involved an involuntary non-resuscitation order.
“Jim, who was about 80 years old, was taken to the hospital at the beginning of the pandemic after feeling sick with a chest infection. Jim, who was still working, was normally fit, well and active and spent most of the week in the car visiting friends or going to the movies, ”the report said.
“About 12 hours after he was hospitalized, Jim called [his daughter] Melanie. He was upset and confused and told him that he had signed his life and that he would die. He told her that a doctor had issued an order not to restart her heart if she stopped. He was upset that he agreed to this because he did not want to die. “
The daughter told the commission that she tried to talk to the medical and nursing staff about the decision.
“Because Jim was able to make decisions about his care, no one discussed the decision with her,” she said, according to the report. “However, she was worried that her father was vulnerable because he was ill, probably confused because he had a serious infection and was alone. She felt that he would leave with what they told her. ”
“Jim died while in hospital,” the report said.
The report is the result of a request from the Department of Health and Welfare to the CQC to conduct a “rapid review of how DNACPR decisions were used during the coronavirus pandemic, based on fears that they were misapplied to groups of people without their knowledge. ”
“It is unacceptable for any DNACPR decision to be taken without proper conversations with the individual or an appropriate representative, taking into account their wishes and needs,” the report said.
An interim CQC report in November 2020 found that “an unprecedented combination of pressure on healthcare providers and rapidly developing guidelines could have led to DNACPR decisions being incorrectly combined with other clinical assessments of critical care, ”said CQC.
Despite positive feedback from most healthcare providers, the CQC has revealed some concerns about the use of locally proposed DNACPR “blanket” decisions.
“During the review process, while inspectors found some examples of good practice, they also found a worrying picture of poor involvement of service users, poor record keeping and lack of oversight and control of decisions made.” , the study said.
The CQC called for government action to address a “worrying variation” in people’s experiences of DNACPR decisions and “to take responsibility for providing improvements in this vital and sensitive area.”
The purpose of the CQC with advocacy to ministers is to focus more on “information, training and support”, as well as a “consistent national approach to advanced care planning” and “improved supervision and provision”, he said.
Correction: An earlier version of this post incorrectly indicated the date on which the CQC interim report was released.