Increasing pressures and rapidly developing guidance may have led to inappropriate use of do not attempt cardiopulmonary resuscitation (DNACPR) decisions during the COVID-19 pandemic, the CQC has found.
In an interim report, the CQC said a combination of unprecedented pressure on care providers and other issues may have led to decisions concerning DNACPR being incorrectly conflated with other clinical assessments around critical care.
The CQC said that while there was no evidence to suggest that blanket DNACPR decisions were being used currently, early in the pandemic people who use services and groups that represent them said they received DNACPR decisions which were not based on their wishes and needs, and without their knowledge and consent.
The regulator said there were differing views remain as to whether people were now receiving appropriate, person-centred care and support around the issue.
Fieldwork is currently underway in seven CCGS to better understand how DNACPRs have been used during the pandemic and what best practice looks like with findings due to be published in early 2021.
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.
“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.”
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.”
Resuscitation Council UK (RCUK) welcomed the CQC’s inclusion of its ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) in the CQC’s best practice approaches for advance care planning, which has been developed with healthcare professionals, patients and their families.
The charity said: “We appreciate this is an interim report and that CQC has further work to carry out as part of its review before publishing its final report. Nevertheless, we hope that by CQC recognising ReSPECT as a tool that can aid individualised discussions and planning, more health and social care organisations will act now to adopt the ReSPECT process in their area. We look forward to CQC defining good practice and setting out clear recommendations early next year, as patients should get good quality, personalised care wherever they live.”