NHS 'too quick to resuscitate acutely ill people'

 

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

Related Stories

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.

 

More on This Story

Related Stories

The BBC is not responsible for the content of external Internet sites

Comments

This entry is now closed for comments

Jump to comments pagination
 
  • rate this
    0

    Comment number 243.

    If you're at an "end of life pathway" situation, then dead is dead - CPR is futile. If you've drowned, had an electric shock or whatever, then CPR may work - but it's only any good if your quality of life will be decent. Otherwise, for me, at least, dead is dead - and if you're dead you won't know any different. I wouldn't want to be a cabbage. Let folks go without drama.

  • rate this
    0

    Comment number 242.

    I work as a lifeguard and recently did an update on defib training, the trainer mentioned DNR's saying to flat out ignore them, when the Paramedic's arrive it's their call not ours. I daresay relatives may find it distressing if someone tries to save their loved one, but it's also distressing to those who are told to watch someone die and of course there is the ever present danger of being sued.

  • rate this
    0

    Comment number 241.

    Doctor's fear of litigation.

    It must be terribly painful, having one's ribs broken during resuscitation.

    Exit International looks increasingly attractive.

  • rate this
    0

    Comment number 240.

    Doctors are sometimes coerced into attempting resuscitation by distressed family who disagree with DNAR decisions, even though legally it is meant to be a clinical decision based on the best interest of the patient above and beyond the wishes of family. The consultant who makes the decision is not the same person who has to oversee the resuscitation should something go wrong that admission.

  • rate this
    0

    Comment number 239.

    My 86-year mother had slipped into a coma and I went immediately but had some distance to travel so arrived late at night.

    I was next of kin but in her notes I found that another, more distant, relative had already agreed to DNR. I was fuming. Surely the doctors can't just take instructions from any relative and should establish next of kin before making DNR decisions.

  • rate this
    0

    Comment number 238.

    If my quality of life becomes low then I will make sure to tell someone my wishes. If you're in pain or paralysed and scared then the worst thing to do is stay alive. My grandfather had the death made in hell. Paralysed, every day enduring hours of almost suffocating, scared, constantly scared, depressed. It was awful. They metal rodded him every few hours down his lungs, he didn't want it.

  • rate this
    0

    Comment number 237.

    My mother became frail and went into a rehab unit after breaking her hip. Her health deteriorated and we were told she would not pull through. Resuscitation was offered as an option. The doctor explained what that meant. It would have been cruel to put a frail, 82 year old through that just for a few more days with her and I couldn't put Mum through that. She died in peace, without pain or trauma.

  • rate this
    0

    Comment number 236.

    The sad reality I see is that hospital doctors are quick to mark patients as DNAR, with indefinite validity & no further review, yet Mostly do not even discuss it with the patient. Ageist life-value-judgments, Dr's frequently hide behind a tick-box that the patient is 'not competent' to discuss it. I find this practice shameful and it deserves to be blown wide-open to full press scrutiny.

  • rate this
    0

    Comment number 235.

    232. blom I was about to post to the same effect.
    Can you imagine the media outcry at those 'Marked for Death in the NHS'.
    Our old DNR forms had green corners and green corners were marked on the ward names board,so at a glance staff could tell who was DNR even if it wasn't their patient,even if the notes weren't regularly available.Even that didnt conform to confidentiality rules so was stopped

  • rate this
    +1

    Comment number 234.

    231 "I find it hard to believe that a hospital doctor has no time to see whether a patient is DNR"
    You're on call covering 200 patients,few you've even met.Crash bleep goes off and you run for 4 minutes dodging people in corridors, to the right ward and patient and start helping save their life, no time to waste. Drs rely on nursing staff knowing which pts to call the crash in the first place.

  • rate this
    +1

    Comment number 233.

    Its a difficult one, in cases of patient who resuscitating is likely to be futile i.e. mutliple medical problems, when you try and have the discussion people are horrified that you would consider not resuscitating either them or their relative. People seem to feel that you are giving up, even when its explained that everything else will be done and the very poor success rate of CPR

  • rate this
    +1

    Comment number 232.

    To all those people that say 'use different coloured armbands', or 'put a sign on the end of the bed', think about what you are saying. Firstly, this would be very much open to abuse, second would breech confidentiality and third would no doubt be distressing for some patients and their relatives. These patients already have a DNR form stapled to the inside of their notes.

  • rate this
    -1

    Comment number 231.

    I find it hard to believe that a hospital doctor has no time to see whether a patient is DNR. It could be something as simple as a different coloured wrist band. Come on people, use a bit of common sense.

  • rate this
    +1

    Comment number 230.

    229 monkeybadger
    Would value your opinion on week-end rotas !

  • rate this
    +4

    Comment number 229.

    As a hospital doctor I am all too aware of the common failings of futile CPR. However, in the rare occasions when it is started innappropriately, I think it is better to start and then abandon the attempt - rather than the opposite which is to delay CPR only to discover that precious minutes have been wasted trying to find out that you should have started already.

  • rate this
    +1

    Comment number 228.

    227 breuddwyd
    When I was wheeling my father around the hospital with his notes,that's how I found out he was not for resus!
    Moving on,still cant believe how senior consultants avoid week-end rotas,there-by rather obviously forcing up mortality rates at week-ends,it's no-brainer stuff of the criminal variety!!

  • rate this
    0

    Comment number 227.

    The Your Views page associated with this article displays grievious misinformation through people who don't know what they are talking about. Talking about deciding to make their relative not for resus (legally they have no right at all) people claiming there is no way to make someone not for resus in the community (GPs can fill a DNACPR form to be kept in their houses/nursing homes and surgery)

  • rate this
    +2

    Comment number 226.

    Do people not understand the meaning of resuscitate in this context? It doesn't mean "keep alive" it means"to bring back to life after the heart has stopped beating".Thats why it is so hard to accomplish, the reason the very sick or old have such a small chance of being brought back or living long after. Success occurs where the cause of the arrest is fixable-loss of blood,drowning,abnormal rhythm

  • rate this
    0

    Comment number 225.

    Puj 'food and drink' arent withdrawn on the pathway,most entering it cannot eat/drink and those that can eat and drink are allowed what they like for their comfort.Your relative COULD NOT eat and drink in any natural way,nutrient support artificially entered into the body in an uncomfortable and nonsustainable way were discontinued as they would prolong her dying therefore suffering,not improve it

  • rate this
    0

    Comment number 224.

    @221 levi199120
    "who gets to make a decision on when someones life 'isn't worth saving' "

    Logan's run aside,

    The point is in realising that there are more medical options than extending existence regardless. The same decision making process should always exist and that is what is best for the patient.

    You don't get to choose to prescribe morphine for the flu.

 

Page 1 of 13

 

More Health stories

RSS

Features

BBC © 2014 The BBC is not responsible for the content of external sites. Read more.

This page is best viewed in an up-to-date web browser with style sheets (CSS) enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so.