Background ReSPECT is a process that creates personalised recommendations for clinical care in a future emergency when unable to express choice. It encompasses cardio-pulmonary resuscitation decision making and supports broader individualised conversations. The process is endorsed by the Resuscitation Council (UK) with Coventry and Warwickshire an early implementer in 2017. This is the first known community audit.
Methods 5 GP practices with care home responsibility were identified. Consent was sought from each practice and care homes were informed. Data was collected by a Macmillan GP or Care Home Lead Nurse on behalf of GP practices (April-June 2019). The proforma was based on a tool used by local acute NHS Trusts.
Results In 224 residents, 114 ReSPECT forms were completed (64%; range 54–96%). In 2 care homes old DNACPR forms were found. 59% were completed in the community with 79% (range 19–100%) completed by a doctor. Demographics were well completed. 28% recorded other Advance Care Planning documents were in place. The goal of care was completed in 48%; of these 96% stated symptom control. Detailed clinical recommendations were recorded in 65% (range 28–81%). The CPR decision was completed in 100%, with 94% DNACPR (range 86–100%). A capacity decision was recorded in 93% and emergency contacts in 38% (range 8–88%).
Conclusions The process has been embedded across Coventry and Warwickshire, however more care home residents could be supported and old DNACPR paperwork should be reviewed. Nurse led completion is more evident in the community. Documentation of patient involvement using the optional personal preference section is limited. The form is widely used as a DNACPR form; the potential for documenting the goal of care and specific clinical recommendations is not being fully utilised and should be a focus for training. Patients and carers could be encouraged to complete the emergency contacts section.
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