Emergency care and resuscitation plans

Abstract

PRACTICE What you need to know• An emergency care plan allows clinicians to discuss and record patient preferences in advance, not only regarding cardiopulmonary resuscitation, but all aspects of care and treatment in an emergency• An emergency care plan provides recommendations for care and treatment for future scenarios when people might not have the capacity to communicate their preferences• Tailor the emergency care plan to consider the most likely individual situations, such as a sudden acute illness, deterioration in a long-term condition, or sudden cardiac or respiratory arrest Box 1: Sources of evidenceThis article draws on an evidence synthesis, 4 two systematic reviews, 5 6 and consensus discussions in a group of stakeholders covering a broad range of care settings and specialties. These stakeholders included nurses, patient representatives, ambulance clinicians, and doctors, who together have developed the ReSPECT process in the UK. 7 The principles described are applicable more generally to discussions about advance planning for future emergencies.Box 2: Some triggers for discussing emergency care plans• Requests by the people themselves• Recognition of long term or complex medical needs-discussions can be started in hospital clinics and wards as well as in general practice• Diagnosis of a life limiting condition-recognition that end-of-life care will be needed• Admission to hospital, especially with an acute illness of any kind• Admission to a care home or nursing home• Identified risk of acute deterioration, cardiac arrest, or death Box 3: What to do when people lack capacity for making decisions about emergency care plans• Discussion with family or other representatives should follow a similar sequence to discussion with a patient (see within "How to have a better conversation")• Try to establish the choices that the person would have made if they had capacity; find out if they have an advance care plan or advance statement recording their preferences, or a legally binding instruction such as an Advance Decision to Refuse Treatment (England & Wales)• Help the family to understand their role: to advise the healthcare team what the patient would have been likely to decide, had he or she had capacity, and what they believe to be in the patient's best interests, but not to make clinical decisions• The senior responsible clinician has ultimate responsibility to make decisions in the person's best interests or for their overall benefit• It is common for relatives to feel that they are being asked to make decisions: take care to avoid this. Explain clearly and exactly how you are asking relatives to help you make the right decision for the patient, and remember to reinforce the same message afterwards, because at these stressful times families often forget or misinterpret what has been said to themIn the UK, the exception to this is if someone has been appointed as legal proxy with powers to make decisions about life sustaining treatment: that person's decisions must be viewed as binding, as long as they...

Exploring family needs in neonatal and pediatric intensive care units at King Khaled Hospital- Jeddah

“…By ensuring this family need, the doctor can proceed with the treatment while confiding in the families about the goal of treatment with outcome measures. Qualitative studies advocate that a timely conversation to discuss the treatment options and relevant consequences can help the families in making difficult decisions to ensure appropriate care [25]. Table 4 shows that the doctors value the family need to ensure the families that the best possible medical care is provided to the critically ill. Our study shows that the need to assure the family that the patient has been treated with the best possible care is also perceived to be very important by nurses (3.65 ± 0.52).…”

General Practitioners’ Experiences of Emergency Care and Treatment Planning in England: A Focus Group Study

“…GPs conceptualised ReSPECT as an end of life care document, to be used as part of advance care planning. ReSPECT was originally designed as an emergency care plan providing concise recommendations for treatment for a future emergency situation (1,16). While the two are complementary they have historically been separate (1); advance care plans are detailed and often focus speci cally on end of life care, whereas emergency plans are more concise and provide recommendations for use in any kind of medical emergency (16).…”

“…ReSPECT was originally designed as an emergency care plan providing concise recommendations for treatment for a future emergency situation (1,16). While the two are complementary they have historically been separate (1); advance care plans are detailed and often focus speci cally on end of life care, whereas emergency plans are more concise and provide recommendations for use in any kind of medical emergency (16). Conceptualising ReSPECT as an end of life document suggests a difference in how general practitioners understand ReSPECT from its designers, and suggests there may be differences in how ReSPECT is being used in primary and acute settings.…”

Advanced care planning during the COVID-19 pandemic: ceiling of care decisions and their implications for observational data

“…It is essential that such discussions occur at an appropriate time and framed within the individual patient's beliefs and wishes. 24 At LTHT, establishing and documenting goals of care were assisted by the availability of the ReSPECT process. 16 This simple electronic documentation is standardised across care settings, and is recognised regionally by hospitals, primary care practices and ambulance services and facilitates timely shared decision-making amongst patients, their next-of-kin and surrogate decision makers.…”