Background Evaluation is an identified mandate following adoption of the Resuscitation Council UK ReSPECT process.¹ Locally, an initial evaluation of new ReSPECT plans in adult secondary care adequately assessed staff compliance against established audit criteria. However, a need for deeper analysis of the narrative within free-text fields was observed. Effective written communication is essential to understanding and informing personalised care and treatment decisions in future emergency situations.

Aim To assess the completeness and quality of documentation practices in achieving the goals of ReSPECT.

Methods A content analysis 2 of 72 ReSPECT plans, using a purposefully designed narrative text audit proforma. The categories and units for analysis were based on the ReSPECT plan (v.3.1) and the ReSPECT guide for clinicians (updated March 2021).³ The nature and frequency of manifest content was analysed to provide direct, clear and objective evidence of documentation practices, amenable to descriptive statistics and visual representation of text data.

Results The findings evidenced a person-centered approach to discussions and decision making, as advocated in the ReSPECT process. A range of appropriate words helpfully conveyed the significance and status of the person’s health, and informed a wide variety of clinical recommendations, usually commencing with the prefix Not for or For. Medical information dominated, with little mention of any personal circumstances, social or communication problems. Clarity was affected by illegible content, common use of abbreviations, a lack of distinction between what the person feared/wished to avoid, and imprecise descriptions/terminology that may not be understood by all or transferable to different settings.

Conclusions The valuable insights acquired for practice supports a routine narrative audit of a sample of ReSPECT plans. The purposefully designed audit proforma appeared capable of pinpointing good documentation practices, and key areas for improvement. Further evaluation is required to establish its validity in additional and alternative contexts of care.

References

1. Resuscitation Council UK. ReSPECT. https://www.resus.org.uk/respect.

2. Denscombe M. (2007) The good research guide for small scale research projects. (3rd Ed). Open University Press: Berkshire.

3. Resuscitation Council UK. ReSPECT Resources. https://www.resus.org.uk/respect/respect-resources.