1. Catherine Baldock Head of Resuscitation, Clinical Skills and Simulation Dr Alistair Brookes Consultant Anaesthetist and Clinical Lead for Resuscitation
Emotive topic, sure there will be some lively discussion. Please save questions to the end of the presentation.

2. Aim To provide an overview of our implementation of ReSPECT:-
Background
Process
Education and training
Launch and implementation
Challenges and current issues
Evidence
Recommendations

3. Background Established and embedded Regional DNACPR policy and form
Patients discharged from the Trust
with DNACPR forms and regularly
readmitted with them (40%)
Previous Regional DNACPR Working Group

4. Background Failed CQC visit around DNACPR Issues with external audit
Complaints and litigation within the Trust linked to DNACPR

6. Process Reconvened DNACPR Working Group as “ReSPECT”
Identified key stakeholders
Representatives from 2 neighbouring Acute Trusts, GP’s, Myton Hospices, ED, Out of hours, Palliative Care, CCG’s, Nursing Homes, WMAS
Fortnightly meetings
Chaired -Head of Resuscitation, Clinical Skills and Simulation
Conscious decision to divorce from EOL
I personally believe this is what DNACPR should be about and that we have a duty to ensure patients are not subjected to CPR when it is futile and a distressing way to end their life.

7. Process
Sought approval to be “early adoption” site (Trusts and Community)
Established reporting structures in each organisation:-
Resuscitation Committee,
EOL,
Medical Management,
Patient Safety Committees
Quality Governance
Agreed timescale and staged launch dates
Agreed wallet design/paperwork
Education and training strategies
Updating operational policies
Overarching policy

8. Education and Training
ReSPECT incorporated into all mandatory
resuscitation training, annual and induction
Presentations at:-
38 QIPS meetings
Ward Manager and Modern Matron meetings
Nursing and Midwifery forums
Junior doctor protected teaching time
GP lunchtime meetings, GP trainee sessions
Nursing/residential homes
Hospices
Staff meetings

10. Education and Training
Learning package for WMAS
ReSPECT posters in all wards and clinical areas
Countdown on Intranet
ReSPECT stand in main hospital
s – form, guidance, information leaflets
Summary in GP newsletter
Summary in local “In Touch” newsletter
Ordering information to all Ward Clerks, Locality Managers, Hospices,

11. Launch day “Going Live” front page of Intranet
All blank red DNACPR forms and wallets removed from both sites and replaced with ReSPECT
Patient Information Leaflets and Clinician’s guide distributed to all wards
Any “new” decisions on that day were made using ReSPECT forms
Any patient’s with a red DNACPR (where possible) changed to ReSPECT prior to discharge
All new admissions – ReSPECT forms

12. Implementation Smooth launch   
Preparation and communication is key
Used in OPD clinics – respiratory, cardiac, renal
No decrease in number of ReSPECT forms
Thank you s and phone calls
Patients requesting ReSPECT forms

13. Challenges
No national policy, no educational material, no information for patients, website not live
First Trust in the country to implement
Not part of the national Working group
Time
Strong personalities
Assumptions…
Patients can have a ReSPECT form and be “For CPR” – patient safety risk

15. Current Issues Still need more education
Some clinicians dislike ReSPECT
Patient Information Leaflet too long and need “easy read” version
Paediatrics not yet adopted ReSPECT in our region
Educational material in development
Large number of Trusts and Communities still to adopt – revert to DNACPR
No electronic form – EMISS and VISION

16. Evidence 164 patients had a ReSPECT form at the time of the audit.
162 forms indicated the patients were “not for CPR” and 2 forms indicated the patient was “for CPR.”
67 patients had mental capacity
99% (n=163) ReSPECT forms:-
-were located at the front of the medical notes,
-recorded the diagnosis, reasons for preferences and recommendations
-were compliant for signatures, name, GMC number, date and time
96% patient demographics were complete
90% -recorded the reason a patient was not for CPR,
-ReSPECT forms were countersigned by a consultant when the form had initially been completed by an ST3 or above

17. Evidence 82% recorded the date on the ReSPECT form
66% of clinicians recorded information about specific interventions that may/may not be clinically appropriate
61% of clinicians detailed the priorities of care  
62% of clinicians signed to indicate priority of care – life sustaining treatment or symptom control
40% of patients had mental capacity
53% of patient’s that had mental capacity had completed the prioritising scale (a number of patients had refused)
52% of patient’s that had capacity had detailed their priorities of care (a number of patients had refused)  
11 patients out of 164 had an Advanced Care Plan.

18. Recommendations Working Group for ReSPECT is essential
Should be led by the Resuscitation Service
Trusts and Community settings should not adopt in isolation
Need to work in collaboration
Staged rollout
ReSPECT is across the whole of the healthcare system
Don’t change your launch date!
You have everything we didn’t have 

20. Summary ReSPECT is the way forward
It puts the patient at the centre of the decision making process
Patients, relatives and staff welcome the change
Clear implementation strategy is key
There will always be some people that don’t like it
Thank You!
I am sure you are all familiar with this. Do have a legal obligation to consult with the relatives.