Blanket DNACPRs ‘unacceptable’ but ‘no evidence’ of their use currently, finds CQC

Patients reported DNACPR decisions which were not based on their wishes and needs, and without their knowledge and consent.

James McKay
3 December 2020
Patient dying

Unprecedented pressure on care providers and other issues caused incorrect DNACPR use.

The Care Quality Commission (CQC) today publishes an interim report from its review into the application of do not attempt cardiopulmonary resuscitation (DNACPR) decisions during the COVID-19 pandemic.

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The CQC says there is “no evidence” to suggest that blanket approaches to DNACPR decisions are being used currently.

However, patients and groups that represent them told CQC that early in the pandemic they or their loved ones received DNACPR decisions which were not based on their wishes and needs, and without their knowledge and consent.

The regulator said that one example, an assessment intended to help clinicians assess frailty as part of a wider assessment around the appropriateness of critical care, may have been interpreted as the sole basis for clinical decisions in some instances.

It has reiterated to healthcare professionals that “It is unacceptable for decisions to be applied to groups of people of any description”.

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Providing further clarity that DNACPR decisions and advance care plans should only ever take place with clear involvement of the individual, or an appropriate representative, and a clear understanding of what they would like to happen.

Very real concerns.

Rosie Benneyworth, Chief Inspector of Primary Medical Services and Integrated Care at the Care Quality Commission said: “It is unacceptable for clinical decisions – decisions which could dictate whether someone’s loved one gets the right care when they need it most – to be applied in a blanket approach to any group of people.

“Sadly, in the experiences that people have generously shared with us there is very real concern that decisions were made which not only overlooked the wishes of the people they affected, but may have been made without their knowledge or consent.

“As we warned in our recent State of Care report, these findings highlight that inequalities in the care people receive risk being magnified by the impact of the coronavirus pandemic. As this is such an important and sensitive issue, we have worked quickly to share these interim findings and we will continue this work so that we build on the evidence already shared and can make recommendations for the future. It is vital that we look at what happened on the ground, continue to speak to people using services and people working in them, so that we can make sure that the health and care system learns the crucial lessons it needs to from this difficult time.

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“We have also highlighted the fact that it is possible in some cases that inappropriate DNACPRs remain in place – and made it clear that all care providers have a responsibility to assure themselves that any DNACPR decisions have been made appropriately, in discussion with the person and in line with legal requirements.”

Person-centred and individualised care.

Andrea Sutcliffe CBE, Chief Executive and Registrar at the Nursing and Midwifery Council (NMC), said: “It’s horrifying to hear of DNACPR orders being applied to anyone without their involvement, consent and their individual needs being taken into account. It’s vital that a clear light is shone on this worrying issue through the ongoing work of the CQC’s review.

“In our joint statement with the General Medical Council (GMC) in the early days of the pandemic, we were absolutely explicit that professionals on our register must practice in line with the NMC Code including following the principles of person-centred and individualised care.

“But it’s clear there’s more to do. Everyone working across health and care has a responsibility to support nurses, midwives and nursing associates to do the right thing and to listen and act on their concerns if they speak up about inappropriate decisions being made.

“I’m glad the NMC has been part of informing the initial scope of this review work. We look forward to continuing this collaboration on the next phase so that high professional standards can be maintained and people’s rights are supported in the best way possible.”

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