Care homes told to enforce ‘do not resuscitate’ orders at Covid height

NHS managers told care homes to put blanket ‘do not resuscitate’ orders on ALL residents at height of Covid crisis, report shows

  • Professor Alison Leary MBE authored the report on DNR orders in care homes
  • One in 10 care home staff were told to change DNR orders for their residents
  • Professor Leary is now calling for an inquiry to be held over the practice

Professor Alison Leary MBE (pictured) wrote the report which found that one in 10 care home staff were told to change resuscitation orders for patients, in some cases without consulting family members first

Professor Alison Leary MBE (pictured) wrote the report which found that one in 10 care home staff were told to change resuscitation orders for patients, in some cases without consulting family members first

NHS managers told care homes to put a blanket ‘do not resuscitate’ order on all of their residents during the peak of the Covid crisis, according to a report.

The Queen’s Nursing Institute found one in 10 care home staff were told to change resuscitation orders for patients. In some cases, they didn’t consult family members first. 

Other care home staff said that at the height of the coronavirus crisis, hospitals were refusing to admit residents from care homes.

The orders mean doctors will not attempt to restart a patient’s heart with defibrillators or cardio-pulmonary resuscitation (CPR). 

Professor Alison Leary MBE, an expert in healthcare and workforce modelling at London South Bank University who wrote the report, said she was surprised to see so many people responding with issues surrounding ‘do not resuscitate’ orders.  

One fifth of the 128 nurses and care home managers involved in the survey claimed to have received patients from hospitals who had tested positive for coronavirus

One fifth of the 128 nurses and care home managers involved in the survey claimed to have received patients from hospitals who had tested positive for coronavirus

hat are Do Not Resuscitate orders and who can invoke them? 

What is a Do Not Resuscitate order?

A DNR order is a legal order which tells a medical team not to perform CPR on a patient. However, this does not affect other medical treatments.

Who can invoke a DNR?

The British Medical Association and the Royal College of Nursing say that DNR orders should only be issued after discussions have been held with patients or their family.

A patient may decline resuscitation if they have capacity as defined under the Mental Health Act 2005.

If patients want to record this in a legally binding document they should plan to make an ‘advance decision to refuse treatment’ (ADRT), but it is often best to have it recorded on a CPR decision form as well, so that healthcare professionals will recognise it easily. Or they can simply ask your healthcare professionals to record your decision on a CPR decision form.

When would it not be appropriate to attempt resuscitation?

Not everyone wants to receive attempted CPR, so it is important to respect people’s wishes and to make sure that they are offered a chance to make choices that are right for them.

When someone’s heart and breathing stop because they are dying from an advanced and irreversible condition, CPR will subject them to a vigorous physical intervention that deprives them of a dignified death. For some people this may prolong the process of dying and, in doing so, prolong or increase suffering.

When there is a chance CPR may bring someone back from cardiac arrest to a length and quality of life that they would want, they should be offered:

The chance to be given clear and accurate information about their condition and the likely risks and benefits from CPR if they should suffer cardiac arrest;

The chance to express their beliefs and wishes and to make a shared decision with their health professionals on whether or not they should receive attempted CPR if they should suffer cardiac arrest.

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She said: ’10 per cent of the respondents raised an issue, because they were either blanket decisions for whole populations, or they were imposed without discussion with the care home or the family or the residents, and that is really worrying.’

Professor Leary also called for an inquiry to be conducted into the way that care homes were dealt with during the crisis. 

One fifth of the 128 nurses and care home managers involved in the survey claimed to have received patients from hospitals who had tested positive for coronavirus.

Almost half of the staff surveyed said that residents sent to them from hospitals had arrived before being tested.

The chief executive of the Queen’s Nursing Institute, Dr Crystal Oldman CBE, said that more needs to be done to understand the pressures faced by care homes during the pandemic. 

Charities have warned throughout the crisis that elderly people across Britain feel they are being pressured into signing ‘do not resuscitate’ forms. 

It led to some British pensioners feeling as if their lives ‘do not matter’, organisations including Age UK and Independent Age wrote in an open letter in April.  

The Care Quality Commission, British Medical Association, Care Provider Alliance and the Royal College of General Practitioners, warned against the practice at the start of the pandemic, calling it ‘unacceptable’.

It comes after the Government was last month pressured into issuing new guidance on ‘do not resuscitate’ orders after a woman threatened legal action over concerns ill coronavirus patients’ human rights were being ignored.

Kate Masters had threatened to sue the Government over its failure to provide consistent advice on DNRs during the Covid-19 pandemic.

She previously said the decision-making process around DNRs had ‘become opaque, inconsistent and deficient’ amid reports of poor practice, including elderly patients apparently being pressured into signing DNR forms, during the crisis.

The Government said it would publish two documents to ensure patients and families understand how DNR decisions are currently being made. 

A study last month revealed more than half of all adult patients treated for coronavirus at a leading hospital were given ‘do not resuscitate’ orders or barred from treatment in intensive care.

Less than one in five patients – 18 per cent – was admitted to the intensive care unit (ICU).

A total of 61 per cent of Covid-19 patients had treatment limitations placed on them on admission to King’s College Hospital in London at the peak of the crisis. This meant they were denied access to potentially life-saving care. 

The study heightened fears about care rationing for elderly and vulnerable patients amid concerns that they were rushed into agreeing do not resuscitate (DNR) orders.   

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