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October 2020

Updated guidance on emergency treatment planning

The Resuscitation Council UK has updated the ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) process to support discussions about care in a future emergency.

As patients are often not able to make decisions about their priorities of care or treatment in an emergency, discussing what they would want to happen in advance is essential.

The COVID-19 pandemic has highlighted the importance of sensitive and well-structured conversations about someone’s realistic care choices and for there to be shared understanding between professionals, patients and their families.

The ReSPECT process is already widely used by health and social care organisations across England and in parts of Scotland to support them having important conversations with patients in advance about their emergency care, and whether cardiopulmonary resuscitation (CPR) should be attempted in a future emergency.

The process includes a discussion guide and form, which is used to document the discussion and any recommendations agreed, is signed by the clinician and can also be signed by the patient or their legal proxy or family member if they wish.

The changes made to the form have resulted in a more patient-centred form, with increased prompts for explicit clinical reasoning. It addresses areas where misunderstandings have been reported and includes more personable and clearer language.

The completed form stays with the patient and should be available immediately to health professionals called to help in an emergency, whether the patient is at home, in their community or in a healthcare setting to enable healthcare professionals to make quick decisions in an emergency in line with the patient’s wishes.

Sue Hampshire, Director of Clinical and Service Development at Resuscitation Council UK said: ‘People have different views about the care or treatments they would want if they were suddenly ill and could not make decisions about their care or treatment. The new form will support better conversations and well-informed decision-making in advance.’

Dr Zoe Fritz, chair of the ReSPECT subcommittee, said: ‘A number of misconceptions exist about CPR and when and how recommendations not to attempt CPR are made. So, it is crucial to have a person-centred approach and conversations that aim to ensure shared understanding between the professional and patient. By doing so, any misunderstandings can be addressed, and professionals can ensure that any recommendations made are based on what’s important to the patient.’

Resuscitation Council UK.

Practice Nurse 2020;50(8):6