More than 500 people in the UK received orders not to “resuscitate” without their consent or the consent of their caregivers during the coronavirus pandemic, according to a study published by the country’s Quality of Care Commission (CQC).
“Since the beginning of the COVID-19 pandemic, there has been concern that decisions should be made about ‘not attempting cardiopulmonary resuscitation’ (DNACPR) without involving individuals, their families and / or caregivers if they so wish, and they applied to groups of people, rather than taking into account the individual circumstances of each, ”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 made since March 17, 2020 “are not they had agreed in a debate with the person, their relative or their caregiver, ”the study said.
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 eighties, was taken to hospital at the start of the pandemic after suffering from a chest infection. Jim, who was still working, had usually been fit, good and active, and he went out most of the week with his car to visit friends or go to the movies, ”the report said.
“About 12 hours after he was admitted to the hospital, Jim called [his daughter] Melanie. He was upset and confused, and told her that he had withdrawn his life and that he would die. He told her that a doctor had issued an order not to have his heart torn again if he stopped. I was upset to have accepted it because I didn’t want to die. “
The daughter told the committee she had tried to talk to medical and nursing staff about the decision.
“Because Jim was able to make decisions about her care, no one had discussed the decision with her,” she said, according to the report. “However, he was worried that his father was vulnerable because he was ill, he was probably confused because he had a bad infection and he was all alone. He felt like he would just go with what they told him. “
“Jim died at the hospital,” the report said.
The report is the result of a request from the Department of Health and Social Care to the CQC to conduct a “rapid review of how DNACPR decisions were used during the coronavirus pandemic, based on concern which were being improperly applied to groups of people without their knowledge “.
“It is unacceptable for DNACPR decisions to be made without proper conversations with the right person or representative, taking into account their wishes and needs,” the report said.
An interim CQC report in November 2020 revealed that “an unprecedented combination of pressure on caregivers and rapid development guidance may have led to DNACPR decisions being incorrectly combined with other clinical assessments around critical attention, ”CQC said.
Despite positive feedback from most care providers, CQC revealed some concerns about the use of “general” DNACPR decisions proposed at the local level.
“Throughout the review process, while inspectors found some examples of good practice, they also found a worrying picture of poor participation of people using services, lack of document registration and lack of supervision and control of the decisions that are being made, ”the study said. dit.
The CQC called for government action to address a “worrying variation” in people’s experiences of DNACPR decisions and “take responsibility for providing improvements in this vital and sensitive area.”
The CQC’s goal with the petition to ministers is to focus more on “information, training and support,” as well as a “consistent national approach to advancing care planning” and “improving oversight and security. “, he said.
Correction: An earlier version of this publication incorrectly indicated the date on which the CQC interim report was published.