More than 500 people in the UK have been subjected to orders not to “resuscitate” without their consent or consent from their caregivers during the coronavirus pandemic, reported a study released by the country’s Quality of Care Commission (CQC) on Thursday.
“Since the beginning of the COVID-19 pandemic, there has been a concern that decisions ‘not to attempt cardiopulmonary resuscitation’ (DNACPR) were being made without involving people, or their families and / or caregivers, if desired, and were being applied to groups of people, rather than taking into account the individual circumstances of each person, ”according to the study by England’s independent health and social care regulator.
Of the 2,048 adult social care providers who responded to the CQC’s request for information, 5.2% (508 out of 9,679) of DNACPR decisions implemented since March 17, 2020 “were not agreed upon in discussion with the person, their relative or caregiver , ”Said the study.
The report includes at least one case study of a man whose death may have involved an involuntary order not to resuscitate.
“Jim, who was in his 80s, was taken to the hospital at the beginning of the pandemic after falling ill with a chest infection. Jim, who still worked, was usually fit, well and active and would go out most of the week in his car to visit friends or go to the movies, ”the report said.
“About 12 hours after being admitted to the hospital, Jim called [his daughter] Melanie. He was upset and confused, and told her that he had given up his life and was going to die. He told her that a doctor had placed an order that they would not restart their heart if they stopped. He was upset that he agreed to this because he didn’t want to die. “
The daughter told the commission that she tried to speak 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 concerned that her father was vulnerable because he was sick, probably confused, because he had a serious infection and was alone. She felt that he would have simply agreed with what they told her. “
“Jim died while in the hospital,” said the report.
The report is the result of a request by the Department of Health and Social Assistance to the CQC to conduct a “quick review of how DNACPR decisions were used during the coronavirus pandemic, based on concerns that they were being applied inappropriately to groups of people without their knowledge. “
“It is unacceptable that any DNACPR decision is made without appropriate conversations with the individual, or an appropriate representative, taking into account their wants and needs,” said the report.
An interim report from the CQC in November 2020 revealed that “a combination of unprecedented pressure on caregivers and rapidly developing guidance may have led to decisions about DNACPR being incorrectly combined with other clinical assessments around intensive care,” he said. the CQC.
Despite the positive feedback from most caregivers, the CQC revealed some concerns regarding the use of DNACPR “cover” decisions proposed at the local level.
“Throughout the review process, although inspectors found some examples of good practice, they also found a worrying picture of insufficient involvement of people using the services, poor record keeping and lack of supervision and scrutiny of the decisions being made. taken, ”says the study. said.
The CQC called for government action to address a “disturbing variation” in people’s experiences with DNACPR decisions and “take responsibility for delivering improvements in this vital and sensitive area”.
The purpose of the CQC with the appeal to ministers is to have a greater focus on “information, training and support”, as well as a “consistent national approach to advanced care planning” and “enhanced supervision and assurance,” he said.
Correction: An earlier version of this post incorrectly stated the date on which the interim CQC report was released.