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37 Recommended Summary Plan for Emergency Care and Treatment (ReSPECT): A Collaborative Model Guiding Care Conversations Between Care Recipients, Families, & Providers
  1. Samantha McIntosh,
  2. Lesley Thorpe,
  3. Tricia Evans and
  4. Vaughn DeCoster
  1. The Royal Wolverhampton NHS Trust, NHS black Country Integrated Care Board, Compton Care, University of Arkansas


Background Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is an interactive process guiding conversations about end-of-life care between a person, their family, and a health care professional. The ReSPECT process was developed to educate and train providers to ensure that decisions are made in advance and consistent with a person’s wishes. Launched in September 2021 across a multicultural conurbation in the West Midlands, instructors trained care professionals and facilitated the model in care homes, hospice and primary care settings. This paper analyses an audit of the ReSPECT model in care homes, offering suggestions for continued utilisation of the model.

Method Adapted to accommodate COVID-19 restrictions, ReSPECT training included face to face, virtual webinars, and regular ‘top tips’ communications. Third Quarter 2022, a single auditor assessed adherence to the ReSPECT model, quality of documents, and diversity of care homes/participants using a systematic chart review.

Results The auditor reviewed 1136 care plans, identifying 350 ReSPECT documents. For 30 audited care homes, 20–40% of residents had ReSPECT documentation, four homes achieved 64–87% completion rates. Medical conditions for 769 care participants in the audit, in order of frequency, were dementia, frailty, hypertension, and diabetes. The quality of documentation and errors varied, e.g., 67% of recipients had charted mental capacity deficits, yet most lacked formal capacity assessments. Variation also existed across professional disciplines conducting the care planning session. Analysis did not reveal any significant demographic differences between care recipients, although smaller homes themselves were more diverse, larger homes more likely to successfully complete and document the ReSPECT process. The recommendations highlight the need for additional training at institutional and provider levels, particularly regarding capacity assessment.

Conclusion The ReSPECT model has potential to improve end-of-life planning and capturing the persons wishes, but additional training and validation is needed to assure consistent adherence.

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