1. Treatment Escalation Plan (TEP) and Resuscitation Decision Record
Myth Buster
Dr Jemma Cooper
Macmillan GP Facilitator

2. Since 2011 now Version 11
Devon wide document used in all health care settings from hospital to home
Developed by working party covering all sectors of health care from acute trusts, to hospices, GPs, Devon Doctors community nurses, SWAST
Well established and well used tool – real success story
Introduced as many different forms in use across Devon leading to confusion and impacting on patient care
TALK THROUGH THE SECTIONS OF THE FORM
However as with anything that has been around for some time it has developed a trail of myths and misunderstandings which potentially can undermine the effectiveness of this excellent end of life care ool

3. Treatment Escalation Plan

4. Resuscitation Decision Record

5. Myth 1
A TEP form is a legally binding document and the decisions recorded on it must be followed ❌

6. example of fracture

7. Myth 2
Only the healthcare professional completing the form can discuss the content with the patient ❌

8. Advanced care planning discussions are everyone’s responsibility
Person may feel more comfortable discussing their future wishes with someone they regularly spend time with such as their paid carer or community nurser
Often opportunities arise during small talk, important not to ignore or avoid cues.
Option for nurses to complete and sign the form depending on competence

9. Myth 3
It is purely a patient decision as to whether they want to be resuscitated or not ❌

10. Would we prescribe antibiotics for a viral infection?
Would we suture a graze?
Would we offer pain relief when the patient has no pain?
Resuscitation should not be offered as an option when it would clearly be unsuccessful
If cardiorespiratory arrest is part of the dying process, CPR will not be successful and is an undignified way to die

11. However the resus council remind us…
If a DNACPR decision is made on clinical grounds that CPR would not be successful there should be a presumption in favour of informing the patient of the decision and explaining the reason for it Those close to the patient should also be informed and offered explanation

12. Myth 4
You don’t need to worry if the patient cannot understand the discussion when completing a TEP form ❌

13. Mental Capacity Act 2005
Always start by assuming the patient has capacity
Decision specific
You must maximise the person’s capacity
All practicable steps must be taken to facilitate communication
An eccentric or unwise decision does not imply lack of capacity

14. Guidance on back of TEP form
Two stages and four questions
How to make a best interest decision
Always start by assuming the patient has capacity
Decision specific
You must maximise the person’s capacity
All practicable steps must be taken to facilitate communication
An eccentric or unwise decision does not imply lack of capacity

15. The form must be completed in its entirety to be valid
Myth 5
The form must be completed in its entirety to be valid ❌

16. Ideally yes…… but as long as signed and dated correctly it is still valid

17. Myth 6
A new form must be completed each time the patient changes healthcare setting ❌

18. Original form should accompany the patient
Should be reviewed to check appropriateness when patient moves healthcare setting but does not need to be re-written

19. A photocopy of an original form is an acceptable substitute
Myth 7
A photocopy of an original form is an acceptable substitute ❌

20. Picture of a red border collie to remind you to use an original form with the red border

21. Any questions?