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
    0

    Comment number 103.

    Surely the important part of this report is not that people are being given resus but the appalling statistic of 1/3 of people having cardiac arrests that could have been prevented. Thank God for private medicine where you are seen by Cardiologists in days rather than weeks. The NHS should bow its head in shame.

  • rate this
    +10

    Comment number 102.

    @101 - if a doctor explained to me that in his expert opinion allowing my relative to die would cause them far less suffering than attempting to resuscitate them with little chance of success then I would be happy to go along with that. My wish would be for my relative to have as peaceful a passing as possible and not have to go through the traum of a resus which would ultimately prove fruitless

  • rate this
    -13

    Comment number 101.

    The fact that comment 91 has been rated negativity proves my point that there are people in this county for whom the sanctity of human life is an issue they are not concerned with.

    I wonder how many people would be happy for a doctor to make life and death decisions regarding a loved one of theirs when that doctors view might be that they should be allowed to die with no attempt to save them?

  • rate this
    -1

    Comment number 100.

    coastwalker #74:
    ""Nurses have to resus until a ward sister or somebody else has time to see if a patient is a DNR"
    So it turns out that your wishes will be overruled because the NHS bureaucracy is set up to deliberately ignore the needs of patients."


    If anything now, the bureaucracy says that if you are acutely ill, the First decision the doctor has to make is if to try resus if you collapse.

  • rate this
    +9

    Comment number 99.

    The problem is drawing the line and protecting the professional - we now live in a culture where taking a professional to court is the norm - becasue the outcome didnt suit someone else. Doctors are left with no choice but to prove they did all they can - whereas actually, in some cases, the best thing to have done was to let the individual die in peace and with dignity.

  • rate this
    +1

    Comment number 98.

    My father is 81 in a month or so, and has not had a doctor for 25 years. He does not want resus under ANY circumsatances. Hard for us, but his decision. I only wish that more clinicians would be brave enough to let people go then some older people wouldn't worry about 'the end'. If I am with him, I will physically stop any attempt to resus, regardless of consequences.

  • rate this
    +4

    Comment number 97.

    As a hospital doctor who spent years on the wards during my junior years, my experience is that inappropriate resuscitation is carried out too often, on patients who have no realistic chance of survival. Forceful chest compressions can break ribs and cause aspiration of stomach contents, particularly in the frail and elderly. This reduces the quality of life if the patient survives.

  • rate this
    +2

    Comment number 96.

    A balanced article regarding a relevant and fraught issue that concerns us all..

    Personally, I'd sign now to be allowed to die of cardiac arrest in given circumstances. Drafting an appropriately worded living will is no easy task. What my solicitor says about being allowed to write anything may be legally true, but what one stipulates must be clinically evaluable in a range of complex situations.

  • rate this
    0

    Comment number 95.

    Unless there are notifications stating "do not Resussitate" on hosptal computer notes or mabey a medical bracelet (like already exist for many illnesses), Resusitation should be attempted until a ER doctor "calls it". It is not up to doctors not to try unless there is real humanitarian reasons.

  • rate this
    +2

    Comment number 94.

    I'm scared by the spelling skills of some of those who describe themselves as medical personnel on here. No wonder patient notes cannot be read quickly and accurately.

  • rate this
    -7

    Comment number 93.

    Umm can't say I like the sound of this, is it the first step to bumping off our `none productive' old folk ?

  • rate this
    +3

    Comment number 92.

    I comment as a daughter & NHS front line staff-My dad had mets CA, a DNR was in place and his death was peaceful with his family around him. It is unacceptable if resus is attempted if a DNR is active,the excuse about finding notes in order to ascertain status is utter codswallop. The clinical team should know the status & the crash team should not be called

  • rate this
    -13

    Comment number 91.

    This worries me because it could be the first step towards the NHS adopting a presumption in favour of DNR for patients who meet certain criteria. I strongly object to DNR on religious grounds and it shows the lack of respect for the sanctity of human life than some people in this country now have. If such a presumption is ever introduced, expect pro-life groups to fight it in the courts.

  • rate this
    +2

    Comment number 90.

    Blom1-"reliant on others to inform them of the patient's resus status"
    If a DNR is in place it should be the first page of their notes, surely not difficult to find?
    The myth of CPR bringing everyone back to life after 30 secs & making fully recovery needs to be stopped. Old & seriously ill people die, let them die in peace & dignity. DNRs need to become the norm for the elderly & terminally ill

  • rate this
    +2

    Comment number 89.

    In his last hours my Stepdad was kept on life support even though the doctors said they could do nothing for him and they were waiting for the bile in his stomach to poison him.
    The fluid in his eyes was dry and he was in a terrible way.
    It was only because I asked for his life support to be turned off that he died with some dignity.
    It's a very difficult decision for a doctor to be put in!

  • rate this
    0

    Comment number 88.

    The option to initiate CPR depends on the chances of success and the quality of life for the patient... Qualitity of life is very subjective therefore doctors will err on the side of caution. Also, it is likely to cause severe distress to someone who has just arrived at hospital to talk about CPR

  • rate this
    -1

    Comment number 87.

    We all die eventually, so is there any point in trying to keep any of us alive? If the answer is "yes", then it must apply to all of us by default. If you decide that one life is less worthy than another, you are automatically wrong.

  • rate this
    -2

    Comment number 86.

    Seriously what is wrong with half of you people and the editors picks?

    Death is never dignified. You can live with dignity; you can't die with it!

    For every whining "oh they died anyway AND had a broken rib how undignified", there's hundreds who LIVED.
    Living is good.
    Dying is bad.

    It really is that simple.

  • rate this
    +6

    Comment number 85.

    I am really fed up with people, who say something and don't know nothing about clinical, medical and nursing care. If we fail to act quickley, we are responsible for it, if we just let it be, we are being victimised by the public, if we resus someone successfully, than mmembers of the family are not happy either ... Yeah just blame the NHS for everything !!!

  • rate this
    0

    Comment number 84.

    "67.
    Peter_Sym
    heart attack beats kidney failure anyday."


    That's given me an idea for a Top Trumps game...

 

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