Catherine Baldock Head of Resuscitation, Clinical Skills and Simulation Dr Alistair Brookes Consultant Anaesthetist and Clinical Lead for Resuscitation Emotive topic, sure there will be some lively discussion. Please save questions to the end of the presentation.

Aim To provide an overview of our implementation of ReSPECT:- Background Process Education and training Launch and implementation Challenges and current issues Evidence Recommendations

Background Established and embedded Regional DNACPR policy and form Patients discharged from the Trust with DNACPR forms and regularly readmitted with them (40%) Previous Regional DNACPR Working Group

Background Failed CQC visit around DNACPR Issues with external audit Complaints and litigation within the Trust linked to DNACPR

Process Reconvened DNACPR Working Group as “ReSPECT” Identified key stakeholders Representatives from 2 neighbouring Acute Trusts, GP’s, Myton Hospices, ED, Out of hours, Palliative Care, CCG’s, Nursing Homes, WMAS Fortnightly meetings Chaired -Head of Resuscitation, Clinical Skills and Simulation Conscious decision to divorce from EOL I personally believe this is what DNACPR should be about and that we have a duty to ensure patients are not subjected to CPR when it is futile and a distressing way to end their life.

Process Sought approval to be “early adoption” site (Trusts and Community) Established reporting structures in each organisation:- Resuscitation Committee, EOL, Medical Management, Patient Safety Committees Quality Governance Agreed timescale and staged launch dates Agreed wallet design/paperwork Education and training strategies Updating operational policies Overarching policy

Education and Training ReSPECT incorporated into all mandatory resuscitation training, annual and induction Presentations at:- 38 QIPS meetings Ward Manager and Modern Matron meetings Nursing and Midwifery forums Junior doctor protected teaching time GP lunchtime meetings, GP trainee sessions Nursing/residential homes Hospices Staff meetings

Education and Training Learning package for WMAS ReSPECT posters in all wards and clinical areas Countdown on Intranet ReSPECT stand in main hospital Emails – form, guidance, information leaflets Summary in GP newsletter Summary in local “In Touch” newsletter Ordering information to all Ward Clerks, Locality Managers, Hospices,

Launch day “Going Live” front page of Intranet All blank red DNACPR forms and wallets removed from both sites and replaced with ReSPECT Patient Information Leaflets and Clinician’s guide distributed to all wards Any “new” decisions on that day were made using ReSPECT forms Any patient’s with a red DNACPR (where possible) changed to ReSPECT prior to discharge All new admissions – ReSPECT forms

Implementation Smooth launch    Preparation and communication is key Used in OPD clinics – respiratory, cardiac, renal No decrease in number of ReSPECT forms Thank you emails and phone calls Patients requesting ReSPECT forms

Challenges No national policy, no educational material, no information for patients, website not live First Trust in the country to implement Not part of the national Working group Time Strong personalities Assumptions… Patients can have a ReSPECT form and be “For CPR” – patient safety risk

Current Issues Still need more education Some clinicians dislike ReSPECT Patient Information Leaflet too long and need “easy read” version Paediatrics not yet adopted ReSPECT in our region Educational material in development Large number of Trusts and Communities still to adopt – revert to DNACPR No electronic form – EMISS and VISION

Evidence 164 patients had a ReSPECT form at the time of the audit. 162 forms indicated the patients were “not for CPR” and 2 forms indicated the patient was “for CPR.” 67 patients had mental capacity 99% (n=163) ReSPECT forms:- -were located at the front of the medical notes, -recorded the diagnosis, reasons for preferences and recommendations -were compliant for signatures, name, GMC number, date and time 96% patient demographics were complete 90% -recorded the reason a patient was not for CPR, -ReSPECT forms were countersigned by a consultant when the form had initially been completed by an ST3 or above

Evidence 82% recorded the date on the ReSPECT form 66% of clinicians recorded information about specific interventions that may/may not be clinically appropriate 61% of clinicians detailed the priorities of care   62% of clinicians signed to indicate priority of care – life sustaining treatment or symptom control 40% of patients had mental capacity 53% of patient’s that had mental capacity had completed the prioritising scale (a number of patients had refused) 52% of patient’s that had capacity had detailed their priorities of care (a number of patients had refused)   11 patients out of 164 had an Advanced Care Plan.

Recommendations Working Group for ReSPECT is essential Should be led by the Resuscitation Service Trusts and Community settings should not adopt in isolation Need to work in collaboration Staged rollout ReSPECT is across the whole of the healthcare system Don’t change your launch date! You have everything we didn’t have 

Summary ReSPECT is the way forward It puts the patient at the centre of the decision making process Patients, relatives and staff welcome the change Clear implementation strategy is key There will always be some people that don’t like it Thank You! I am sure you are all familiar with this. Do have a legal obligation to consult with the relatives.