More than 500 people in the UK were ordered “do not resuscitate” during the coronavirus pandemic without their consent or the consent of their caregivers, a study published Thursday by the country’s Care Quality Commission (CQC) reported.
“From the start of the COVID-19 pandemic, there were concerns that ‘no attempted cardiopulmonary resuscitation’ (DNACPR) decisions were made without involving people, or their families and / or carers, and applied to groups of people, rather than taking into account the individual circumstances of each person, ”said the study by the independent regulator of health and social care in England.
Of the 2,048 adult social care providers who responded to the CQC’s information request, 5.2% (508 out of 9,679) of the DNACPR decisions made since March 17, 2020 were “ not agreed upon in consultation with the individual, their relative or caregiver, ‘the study said.
The report includes at least one case study of a man whose death may have been accompanied by an involuntary order not to resuscitate.
“Jim, in his eighties, was taken to hospital at the start of the pandemic after becoming unwell from a chest infection. Jim, who was still working, was normally fit, healthy and active and spent most of the weeks in his car visiting friends or going to the cinema, ”the report said.
About 12 hours after admission to the hospital, Jim called [his daughter] Melanie. He was upset and confused and told her that he had given up his life and was going to die. He told her that a doctor had issued an order that they would not restart his heart if it stopped. He was angry that he agreed because he didn’t want to die. “
The daughter told the committee she had tried to talk to the medical and nursing staff about the decision.
“Because Jim was able to make decisions about his care, no one had discussed the decision with her,” she said, according to the report. However, she was concerned that her father was vulnerable because he was sick, would likely become confused because he had a serious infection, and he was all alone. She felt he would have just gone with what they told him. “
“Jim died while in the hospital,” the report said.
The report is the result of a request from the Department of Health and Social Care to the CQC to conduct a “rapid evaluation of how DNACPR decisions were used during the coronavirus pandemic, building on concerns that they were inappropriately applied to groups of people without their knowledge. “
“It is unacceptable that DNACPR decisions are made without proper discussions with the individual or an appropriate representative, taking into account their wants and needs,” the report said.
An interim report from the CQC in November 2020 revealed “a combination of unprecedented pressure on health care providers and rapidly evolving guidelines may have resulted in decisions about DNACPR being falsely combined with other clinical assessments around critical care,” said CQC.
Despite positive feedback from most health care providers, CQC raised some concerns about the use of “generic” DNACPR decisions proposed at the local level.
“During the review process, while inspectors found some examples of good practice, they also found a disturbing picture of the poor involvement of people using services, poor record-keeping and a lack of monitoring and control over the decisions made,” said the inquiry said.
The CQC called for government action to address a “worrying variation” in people’s experiences of DNACPR decisions and “to take responsibility for delivering improvements in this vital and sensitive area.”
The goal of the CQC in advocating for ministers is to have a greater focus on “information, training and support” as well as a “consistent national approach to promote care planning” and “improved oversight and assurance,” it said. .
Correction: An earlier version of this post incorrectly stated the date the CQC Interim Report was released.