NHS 'too quick to resuscitate acutely ill people'

 

Dr George Findlay: "CPR decisions need to come to the fore"

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Some of the most frail elderly patients are suffering "distressing" deaths because hospitals wrongly try to resuscitate them, a watchdog says.

The National Confidential Enquiry into Patient Outcome and Death reviewed the care given to 585 acutely-ill patients who ended up having a cardiac arrest.

The watchdog concluded that cardiopulmonary resuscitation (CPR) had wrongly become the default setting.

And it said a third of the cardiac arrests could have been prevented.

The report concluded assessing if resuscitation was necessary should become standard.

Warning signs

The review, which looked at patients with an average age of 77, also looked at the standards of care given to these patients.

It found that staff were not properly assessing their condition and were failing to spot the warning signs of an impending cardiac arrest.

Details of whether or not to give CPR was recorded in the notes of only 122 patients in the study of hospitals in England, Wales and Northern Ireland.

Of these, there were 52 cases where doctors had performed resuscitation on patients who had explicitly said they did not want it.

The experts said performing CPR in inappropriate cases could result in a distressing and undignified death.

They gave the example of an elderly patient with severe dementia who had CPR performed on them for 10 minutes until a senior doctor stopped the team. The report said resuscitation should not have taken place.

'Crossroads'

NCEPOD chairman Bertie Leigh said there needed to be a rethink by the NHS about what was possible for these patients.

"We are at a crossroads. All of us need to recognise and accept the limits of what can be achieved in medicine to the benefit of the patient."

Katherine Murphy, of the Patients Association, said there was a "huge degree of confusion" about the issue.

"Patients and relatives deserve to have all of their options communicated to them in full and then to take the decision that they feel is best for them.

"Once that decision has been taken, they should be able to trust clinicians to implement it."

Dr Mark Temple, an acute medicine fellow at the Royal College of Physicians, said the report did not make it clear why the patients had resuscitation, and whether this was because of poor documentation or staff handover.

He questioned whether it was an issue about having a correct "not for resuscitation" order made initially.

In an emergency, when a patient's status may change, a "snap decision" could be made by staff to proceed with CPR, he said.

 

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  • rate this
    +23

    Comment number 70.

    As a retired Ambulance Technician I can say that services across the country need a better, more joined up approach to resuscitation. Most protocols insist that resuscitstion is attempted, almost regardless of the situation. Having attempted to "revive a corpse" on many occassions and broken many a rib in the process I can emphasise how difficult it can be for clinicians in hopeless circumstances.

  • rate this
    +20

    Comment number 69.

    I think a change in the public view of resuscitation is needed. Far from the dramatics portrayed on the television, CPR results in broken ribs, is not dignified and is more often than not unsuccessful. Even if an output is returned, the quality of life and the prognosis for patients are often not great. I think if people understood more about it then maybe we could discuss DNR more openly.

  • rate this
    +24

    Comment number 56.

    I'm a hospital doctor. When a cardiac arrest happens, doctors from all over the hospital are summoned to the clinical area and are committed to attempting resuscitation. They usually do not know the patient and are thus reliant on others to inform them of the patient's resus status. This is why some resuscitations happen when the patient is DNR. There is no time to wait to check.

  • rate this
    +11

    Comment number 42.

    In the final hours of my late father's life he was subjected to CPR which broke his ribs. When I was eventually able to get to the hospital a senior doctor agreed that he should be left to die in peace. I concur with the reports findings - it is better with elderly patients at the end of their life to let nature take its course

  • rate this
    +6

    Comment number 41.

    The hardest thing in life is too let someone go. Whether children leaving home or someone dying. This is the same for medical staff, patients, as well as family. As we are all human I think this will always be a problem. Too many times a CPR descision should have been made, but it is easier to continue with the status quo than make these difficult decisions.

 

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