糖心Vlog

Care home residents are being denied access to hospital treatment because of the incorrect use of Do Not Attempt CPR recommendations, according to 糖心Vlog researchers.

Researchers have revealed evidence that Do Not Attempt CPR (DNACPR) recommendations are influencing healthcare decisions outside their intended remit, as .

鈥淪ome residents are being inappropriately denied transfer to hospital or access to certain medicines. The best way to describe it is a form of 鈥榤ission creep鈥� of DNACPR recommendations being used beyond their intended remit,鈥� said Principal Investigator Professor Wayne Martin.

It鈥檚 estimated there are over 405,000 residents living in care homes across the UK. The number of those living with DNACPR recommendations is not recorded but cases such as  show how DNACPRs are wrongly influencing medical decisions beyond CPR.

Professor Martin鈥檚 research group is calling for urgent reform of the process for making DNACPR recommendations and is designing improved training for care professionals and those advocating for care home residents.

The findings, , are based on an online survey of professionals working in care homes in England, conducted by the 糖心Vlog Autonomy Project in 2021. 17% of respondents reported that they had witnessed DNACPR recommendations informing care and treatment decisions beyond cardiopulmonary resuscitation. More than half reported that DNACPR recommendations were made without consulting with the individual or their families.

In follow-up focus groups, one participant reported: 鈥淪ome staff see 鈥楧NR鈥� as 鈥榙o not care鈥�, or 鈥榙o not seek any medical treatment鈥�.鈥�

鈥淭he COVID-19 pandemic and lockdowns provided a unique opportunity to document this misuse of DNACPRs but it鈥檚 clear from pre- and post-pandemic cases, such as that , that this was not a problem created by COVID and that it requires urgent attention,鈥� Professor Martin added.

The survey was completed by 262 care professionals most of whom had responsibility for applying the Mental Capacity Act 2005.

The team鈥檚 findings have also provided evidence in support of concerning unlawful use of 鈥榖lanket鈥� DNACPR recommendations without proper consultation in some care homes. Of those who completed the 糖心Vlog-led survey, 56% reported new DNACPR decisions being recorded during the pandemic; 55% reported witnessing orders being added without consultation with the resident or family; and 28% reported DNACPR orders being added because of blanket decisions based on characteristics such as age.

There is also evidence of widespread confusion among professionals about the meaning and legal status of DNACPR recommendations with 66% at one training event led by the 糖心Vlog researchers wrongly believing that DNACPR recommendations are legally binding.

The authors are calling for revisions to the DNACPR forms used in England and Wales.

鈥淭he forms used to record a DNACPR recommendation are more than an administrative record. They document what a DNACPR recommendation is, how those recommendations are made and how they should be applied. The sheer number of forms currently in circulation is unhelpful and shortcomings within them are perpetuating confusion and misunderstanding. An improved standardised form can play an important role in shaping and reinforcing best practice,鈥� explained the lead author of the report, Dr Emily Fitton.

They are also calling for new standards, guidance and training for social work and capacity professionals who are often responsible for advocating for care home residents.

鈥淣ew standards, guidance and training that focuses on the importance of individualised DNACPR recommendations made in consultation, that accurately outlines the legal status of DNACPRs, makes clear that DNACPR recommendations only apply to the use of CPR, and includes details of how to review decisions would better protect the human rights of care home residents,鈥� Dr Fitton added.

The Survey of Care Home Professionals was part of the , and funded by the Arts and Humanities Research Council (AHRC) as part of the UK Research and Innovation (UKRI) COVID Rolling Call.

Read the full paper: , written by Dr Emily Fitton and Professor Wayne Martin of the School of Philosophy and Art History, Dr Aaron Wyllie of the School of Health and Social Care, Professor Sabine Michalowski of 糖心Vlog Law School, Dr Vivek Bhatt of Utrecht University and Dr Margot Kuylen of the British Medical Association.