An Advanced Care Plan (ACP) allows discussion and documentation of patient preferences for future medical care, not only limited to resuscitation. Despite national guidance, communication remains poor and there is inconsistent documentation of ACP and DNACPR decisions, potentially resulting in inappropriate treatment and unnecessary hospital admissions. ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) is a newly introduced emergency care plan which aims to help support discussions and record recommendations. We assessed the quality of ACP and DNACPR documentation at a UK District General Hospital before and after introducing ReSPECT.
Retrospective data was collected on all patients from elderly care wards (one male and one female) in March 2018 and March 2019 through case-note review following ReSPECT going live in October 2018. Section headings on the form were used as basis for collection. Data also included ACP/DNAR decision communication on discharge paperwork.
The March 2018 cohort included 87 patients (35 female and 52 male) with 113 patients (67 female and 46 male) in March 2019. In patients who had an ACP discussion, there was an increase from 68.2% to 100% of the specific nature around this documented, and it was communicated better in discharge documentation (81.8% to 100%). Furthermore, in patients whom DNACPR was agreed, there were improved levels of recorded documentation from 79.4% to 87.1%.
ACP and DNACPR decisions are individual to each patient and pre-ReSPECT form data shows documentation was poor. However, following introduction of the ReSPECT form there were significant improvements noted in two key areas - in clinical notes for DNACPR decisions and subsequent discharge paperwork, and following ACP discussions there was an improved level of documentation regarding the specific nature of the ACP. We have demonstrated that the ReSPECT form can empower clinicians to ensure patients have an appropriate care plan documented to guide future care.
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