ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. It is an emergency care and treatment plan (ECTP) used in parts of the United Kingdom, in which personalized recommendations for future emergency clinical care and treatment are created through discussion between health care professionals and a person (or their legal proxy or those close to them). [1] These recommendations are then documented on a ReSPECT form. [2]
The ReSPECT process is centred around conversations which aim to develop a shared understanding between the healthcare professional and a person about their condition, the outcomes the person values and those they fear [3] and then how treatments and interventions (such as cardiopulmonary resuscitation (CPR), ventilation, intravenous medication, or admission to intensive care) fit into this. [4] It supports the important principle of personalised care, [5] moving away from a yes/no CPR decision to one that is more nuanced and patient centred. [6]
A person's ReSPECT form includes recommendations about emergency treatments that could be helpful and should be considered, as well as those not wanted by or that would not work for them. [4] It includes a recommendation about cardiopulmonary resuscitation (CPR), but that may be a recommendation that CPR is attempted, or a recommendation that it is not attempted. [7]
ReSPECT forms are not legally binding but can be used by health care professionals to guide them when providing treatment for the person in a future emergency situation. [8] As the ReSPECT process and form are designed to be recognised across different care settings (for example between hospitals, primary care, ambulance services, or care homes) and to cross geographical boundaries, the person does not have to undertake repeated conversations and discussions. [8]
ReSPECT was developed after attendees at a 2014 summit at the Royal Society of Medicine on Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions in the UK criticised the variability and problematic practice linked to standalone DNACPR decisions. [9] In particular DNACPR decisions were not routinely considered, [10] were often poorly discussed or not discussed at all, [11] [12] and were misunderstood to mean that other care should be withheld. [13] [14] [15] [16] Alternative approaches had been developed internationally including Physician Orders for Life-Sustaining Treatment (POLST) for those approaching the end of their lives. One such approach, which contextualised the CPR decision within overall goals of care, the Universal Form of Treatment Options (UFTO), was found to address many of the issues associated with standalone DNACPR decisions. [17] [18] This data was presented to the UK Government's Health Select Committee who recommended that "the Government review the use of DNACPR orders in acute care settings, including whether resuscitation decisions should be considered in the context of overall treatment plans" and suggested standardising the recording mechanisms for the NHS in England. [19] The Department of Health responded positively to this recommendation for improved processes focused on patient goals. In 2015 it documented that a working group had been established "to develop a national form that records decisions about CPR and other life-sustaining treatment in the context of a broader plan”. [19] Development of the ReSPECT process involved a review of literature, a national consultation, interviews with healthcare professionals and members of the public, a workshop with patients and public, and a usability trial. [9]
The ReSPECT process is used in around 70% of counties in England and in some areas of Scotland. In the UK, 21% of hospitals had adopted ReSPECT by December 2019. [20] ReSPECT is the fastest growing ECTP in the UK, as many hospitals move away from using standalone DNACPR forms,. [20] It is recommended in policy and guidance documents for doctors. [21] [22] [23] Some NHS hospitals in need of improvement are required to ensure that staff are competent in using ReSPECT. [24] [25]
In 2020 it emerged that blanket DNACPR orders had been applied to UK care home residents during the COVID-19 pandemic, [26] leading to concerns that people's individual circumstances had not been assessed and the person concerned was not involved in the decision making. [27] These blanket orders were investigated by the Care Quality Commission, who cited ReSPECT as one of the best practice approaches in their interim report, [27] because having conversations to understand patients’ wishes about resuscitation is particularly important in the pandemic. [28]
A pilot of the ReSPECT process in NHS Forth Valley conducted in 2017–19, found that it led to multiple improvements. Patients and carers felt more involved in decision-making and rated the process positively (80% rating their experience as excellent and 20% as good), and staff were better able to access the information to inform decision-making in an emergency. [29]
A wider evaluation of the use of ReSPECT [20] in hospitals in England, during the early stages of adoption found the following:
Cardiac arrest is when the heart stops beating. It is a medical emergency that, without immediate medical intervention, will result in cardiac death within minutes. When it happens suddenly, it is called sudden cardiac arrest. Cardiopulmonary resuscitation (CPR) and possibly defibrillation are needed until further treatment can be provided. Cardiac arrest results in a rapid loss of consciousness, and breathing may be abnormal or absent.
Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. It is recommended in those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.
Clinical death is the medical term for cessation of blood circulation and breathing, the two criteria necessary to sustain the lives of human beings and of many other organisms. It occurs when the heart stops beating in a regular rhythm, a condition called cardiac arrest. The term is also sometimes used in resuscitation research.
Advanced cardiac life support, advanced cardiovascular life support (ACLS) refers to a set of clinical guidelines for the urgent and emergent treatment of life-threatening cardiovascular conditions that will cause or have caused cardiac arrest, using advanced medical procedures, medications, and techniques. ACLS expands on Basic Life Support (BLS) by adding recommendations on additional medication and advanced procedure use to the CPR guidelines that are fundamental and efficacious in BLS. ACLS is practiced by advanced medical providers including physicians, some nurses and paramedics; these providers are usually required to hold certifications in ACLS care.
Mouth-to-mouth resuscitation, a form of artificial ventilation, is the act of assisting or stimulating respiration in which a rescuer presses their mouth against that of the victim and blows air into the person's lungs. Artificial respiration takes many forms, but generally entails providing air for a person who is not breathing or is not making sufficient respiratory effort on their own. It is used on a patient with a beating heart or as part of cardiopulmonary resuscitation (CPR) to achieve the internal respiration.
A do-not-resuscitate order (DNR), also known as Do Not Attempt Resuscitation (DNAR), Do Not Attempt Cardiopulmonary Resuscitation (DNACPR), no code or allow natural death, is a medical order, written or oral depending on country, indicating that a person should not receive cardiopulmonary resuscitation (CPR) if that person's heart stops beating. Sometimes these decisions and the relevant documents also encompass decisions around other critical or life-prolonging medical interventions. The legal status and processes surrounding DNR orders vary from country to country. Most commonly, the order is placed by a physician based on a combination of medical judgement and patient involvement.
An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of patients who present without prior appointment; either by their own means or by that of an ambulance. The emergency department is usually found in a hospital or other primary care center.
Dying is the final stage of life which will eventually lead to death. Diagnosing dying is a complex process of clinical decision-making, and most practice checklists facilitating this diagnosis are based on cancer diagnoses.
Life support comprises the treatments and techniques performed in an emergency in order to support life after the failure of one or more vital organs. Healthcare providers and emergency medical technicians are generally certified to perform basic and advanced life support procedures; however, basic life support is sometimes provided at the scene of an emergency by family members or bystanders before emergency services arrive. In the case of cardiac injuries, cardiopulmonary resuscitation is initiated by bystanders or family members 25% of the time. Basic life support techniques, such as performing CPR on a victim of cardiac arrest, can double or even triple that patient's chance of survival. Other types of basic life support include relief from choking, staunching of bleeding by direct compression and elevation above the heart, first aid, and the use of an automated external defibrillator.
Dead on arrival (DOA), also dead in the field and brought in dead (BID), are terms which indicate that a patient was found to be already clinically dead upon the arrival of professional medical assistance, often in the form of first responders such as emergency medical technicians, paramedics, firefighters, or police.
Basic life support (BLS) is a level of medical care which is used for patients with life-threatening illnesses or injuries until they can be given full medical care by advanced life support providers. It can be provided by trained medical personnel, such as emergency medical technicians, and by qualified bystanders.
Artificial ventilation is a means of assisting or stimulating respiration, a metabolic process referring to the overall exchange of gases in the body by pulmonary ventilation, external respiration, and internal respiration. It may take the form of manually providing air for a person who is not breathing or is not making sufficient respiratory effort, or it may be mechanical ventilation involving the use of a mechanical ventilator to move air in and out of the lungs when an individual is unable to breathe on their own, for example during surgery with general anesthesia or when an individual is in a coma or trauma.
Pulseless electrical activity (PEA) refers to cardiac arrest in which the electrocardiogram shows a heart rhythm that should produce a pulse, but does not. Pulseless electrical activity is found initially in about 20% of out-of-hospital cardiac arrests and about 50% of in-hospital cardiac arrests.
ABC and its variations are initialism mnemonics for essential steps used by both medical professionals and lay persons when dealing with a patient. In its original form it stands for Airway, Breathing, and Circulation. The protocol was originally developed as a memory aid for rescuers performing cardiopulmonary resuscitation, and the most widely known use of the initialism is in the care of the unconscious or unresponsive patient, although it is also used as a reminder of the priorities for assessment and treatment of patients in many acute medical and trauma situations, from first-aid to hospital medical treatment. Airway, breathing, and circulation are all vital for life, and each is required, in that order, for the next to be effective. Since its development, the mnemonic has been extended and modified to fit the different areas in which it is used, with different versions changing the meaning of letters or adding other letters.
The chain of survival refers to a series of actions that, properly executed, reduce the mortality associated with sudden cardiac arrest. Like any chain, the chain of survival is only as strong as its weakest link. The six interdependent links in the chain of survival are early recognition of sudden cardiac arrest and access to emergency medical care, early CPR, early defibrillation, early advanced cardiac life support, and physical and emotional recovery. The first three links in the chain can be performed by lay bystanders, while the second three links are designated to medical professionals. Currently, between 70 and 90% of cardiac arrest patients die before they reach the hospital. However, a cardiac arrest does not have to be lethal if bystanders can take the right steps immediately.
The history of cardiopulmonary resuscitation (CPR) can be traced as far back as the literary works of ancient Egypt. However, it was not until the 18th century that credible reports of cardiopulmonary resuscitation began to appear in the medical literature.
End-of-life care refers to health care provided in the time leading up to a person's death. End-of-life care can be provided in the hours, days, or months before a person dies and encompasses care and support for a person's mental and emotional needs, physical comfort, spiritual needs, and practical tasks.
Resuscitation Council UK (RCUK) is a healthcare charity focused on resuscitation education and training for healthcare professionals and bystander CPR awareness for the public. It is the United Kingdom body responsible for setting central standards for CPR and related disciplines. RCUK is a member of the European Resuscitation Council, which is part of the international standards body, the International Liaison Committee on Resuscitation (ILCOR).
POLST is an approach to improving end-of-life care in the United States, encouraging providers to speak with the severely ill and create specific medical orders to be honored by health care workers during a medical crisis. POLST began in Oregon in 1991 and currently exists in 46 states; some of the 46 states have the program in development. The POLST document is a standardized, portable, brightly colored single page medical order that documents a conversation between a provider and an individual with a serious illness or frailty towards the end of life. A POLST form allows emergency medical services to provide treatment that the individual prefers before possibly transporting to an emergency facility.
Slow code refers to the practice in a hospital or other medical centre to purposely respond slowly or incompletely to a patient in cardiac arrest, particularly in situations for which cardiopulmonary resuscitation (CPR) is thought to be of no medical benefit by the medical staff. The related term show code refers to the practice of a medical response that is medically futile, but is attempted for the benefit of the patient's family and loved ones. However, the terms are often used interchangeably.
{{cite journal}}
: Cite journal requires |journal=
(help)