Variation in do not attempt cardiopulmonary resuscitation orders and emergency care and treatment plan use in English acute hospitals : a national survey

Purpose of the study Variation in the recording of DNACPR decisions between healthcare organisations creates policy and communication challenges when patients are transferred between organisations. A recent UK stud y identified the need for a nationwide system to record resuscitation decisions alongside other treatment escalation decisions. The development of the UK - based Recommended Summary for Emergency care and Treatment Plan (ReSPECT) process was a response to this need. ReSPECT has been available to healthcare organisations to adoption since Spring 2017. The purpose of this study was to record current variation in the way in which DNACPR decisions are recorded in UK hospitals and identify the current uptake of the ReSPECT process. Materials and methods We conducted an online survey between October 2017 and March 2018 of all UK adult NHS hospitals participating in the National Cardiac Arrest Audit (NCAA). Descriptive statistics were used to report the results. Results Of the 187 hospitals surveyed, 114 (61%) responded. Most hospitals reported using a DNACPR form (n=57, 50%). Other hospitals used either a DNACPR form with separate treatment escalation plan (n=35, 31%), an ECTP or DNACPR form combined with a treatment escalation plan (n=20, 18%), or another system (n=2, 2%). In total, 8 hospitals (7%) were using the ReSPECT system. Conclusions There is variation in the way in which DNACPR decisions are recorded in UK hospitals. To date, only a small number of hospitals have implemented the ReSPECT process