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
    +10

    Comment number 43.

    In counterargument to those who say the Queen or Prince Philip would be kept alive regardless check out what happened to her father George VI. Its widely reported he was given a 'Brompton Cocktail' (google that) to speed his passing and minimise the pain he was in. The doctor attending to him as much as admitted it. I work in a cancer unit and think 'lucky George....'

  • 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.

  • Comment number 40.

    All this user's posts have been removed.Why?

  • rate this
    -29

    Comment number 39.

    Anyone who states that they do not wish to be resuscitated ought to be sectioned under the mental health act and then forcibly treated.

  • rate this
    +9

    Comment number 38.

    When I request not to be resuscitated it is my polite way of giving an order to those concerned. What I am saying is I DON'T WANT TO BE RESUSITATED. Surely that is easy to understand.

  • rate this
    +1

    Comment number 37.

    @34. Ex Tory Voter:

    They already are.. google QALYs

  • rate this
    +5

    Comment number 36.

    Being a nurse, i think it's important to note that if a resus status is not readily available when someone has a cardiac arrest we are taught to perform resus until the status is confirmed. This of course results in many individuals being resucitated when they shouldn't be, if we didn't attempt to resucitate and the person was for resus we would get it in the neck.

  • rate this
    +4

    Comment number 35.

    I think there are more good things about this story than bad; surely it is great that we have a health service desperate to keep people alive and in the best possible condition.

    When Fabrice Muamba had a cardiac incident, his heart had stopped for over an hour, around 87 minutes I think, and he was saved!

    It would be more distressing to know doctors had given up too early on your ill relative!

  • rate this
    +3

    Comment number 34.

    Never mind, when the NHS is fully privatized such decisions will be purely made on cost grounds.

  • rate this
    0

    Comment number 33.

    yeah yeah
    everything the NHS is doing is rubbish and thats why the NHS staff should get crap salaries and this is what I always hear but the truth is different : I am proud working for the NHS and I belief medical and nursing staff have a dedications overpaided Bankers, greedy Footballers never ever have ! Nursing staff are being victimised by the public patient say !

  • rate this
    +2

    Comment number 32.

    Having been in that distressing situation with my late mother, I fully agree with the watchdog's findings.

  • rate this
    +2

    Comment number 31.

    #21 The problem is that if a doctor sits back and does nothing he DOES risk serious trouble if not accusations of being another Shipman & he's had several malicious lawsuits from patients relatives when patients have died (he treats advanced cancer cases... most of them die). If a patient has a cardiac arrest the safest thing to do is attempt to save their life.

  • rate this
    +2

    Comment number 30.

    Each case must be taken on clinical merit, something which may be lost in the quantative number crunching process.
    The NHS does not strive officiously to maintain life where it is clear that all quality of life is absent. Non resuscitation requests are exactly that, requests. The decision to resuscitate or not must always lie with the clinician.

  • rate this
    +1

    Comment number 29.

    I'm sure it would mean a far more efficient use of NHS resources also, were we to go the other way. But seriously, is this all a Swiftian proposal? It's hard to tell, the way things have gone with policy decisions over the last couple of years.

  • rate this
    +2

    Comment number 28.

    I believe that a number of CPR situations come about without need due to pressure put on by relatives who want their loved ones to ok. So as a Nurse or Doctor do you a) Say no, it is not in the best interests of the patient and then have yourself investigated following a complaint or b) do all you can so that relatives know you didn't just give up and have explored options. Compensation anyone?

  • rate this
    -9

    Comment number 27.

    @ 11. Agree with some of your points . . . the NHS treats people cheaply. The service received therefore is undoubtedly value for money if you consider that you get what you pay for. We spend way less on healthcare in this country per capita than all other 'westernised' countries.
    World class treatment? Probably if you take a world average to mean late, ineffective, scary treatment.

  • rate this
    0

    Comment number 26.

    we need to ask the question of the person at an early stage, most will have a period where they can make the decision for themselves those that cant a panel should make the decision for them so no 1 person could be blamed. in an emergency CPR should be given 1 time before discussions/decisions are made and clear marking of those who do not want CPR should exist to indicate the decision/choice

  • rate this
    -1

    Comment number 25.

    Just wait until the NHS is fully privatised....
    You will get resus'ed(with or without your permission) then billed for it.....

    Thatcher's Britain, oh no sorry...
    Cameron's Britain......

  • rate this
    0

    Comment number 24.

    I think the best test is this: If the person in question was the Queen, would an effort be made to save the life? I always feel different standards apply to different people. The NHS can do brilliant things, but I am not convinced the very best is always available to everyone.

    The Government have a vested interest in "elderly survival rates".

 

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