CNO to review form after concerns raised over DNR question
The chief nursing officer is to review the way community nurses discuss end of life care with older patients, particularly wishes concerning resuscitation, following criticisms in the national media.
Writing in her latest blog, CNO for England Jane Cummings said she was disappointed at reports claiming dialogue with patients over their wishes concerning resuscitation was handled in a blunt and impersonal way.
“We will review the form again, with patients and clinical staff, in the light of the poor experiences described in the media”
It follows claims that patients were being asked whether they would agree to a “do not resuscitate” order by district nurses they have not met before, under an NHS England questionnaire scheme.
Health policy analyst Roy Lilley told the Daily Mail he had been contacted by relatives of elderly patients with concerns about the form, including two that were asked over the phone. He claimed the question was inappropriate, especially if asked by someone who had not previously met the patient.
Ms Cummings said she had spoken with Mr Lilley, who described the experience his mother had, which she noted was “upsetting and should not have happened”.
“As a nurse, I was very disappointed to hear that story,” she said, adding that most nursing staff “would never dream” of asking patients where and how they would like to die in an “insensitive or bureaucratic way”.
“It needs to be part of an ongoing discussion that develops out of a meaningful relationship between a nurse and patient and their families,” she said. “The aim is not simply to work through a document and tick it off, but to ensure that every patient’s questions, concerns and options have been addressed.”
Ms Cummings said the document in question – Avoiding unplanned admissions enhanced service: Proactive case finding and care review for vulnerable people – was intended to help clinicians develop personalised care plans with vulnerable patients who had complex healthcare needs.
The form includes questions on allergies, medication and people’s emergency contacts. One question relates to emergency care and mentions resuscitation as a possible discussion point.
“Clearly if this conversation is appropriate for the patient, and as the form suggests it might not be, then it should be handled with great care,” she said Ms Cummings.
“We will review the form again, with patients and clinical staff, in the light of the poor experiences described in the media and make any changes that are needed,” she said.
“Compassionate care should be at the heart of all conversations and relationships between a nurse and patient. Poor implementation of a document by individuals is no excuse for causing distress to our most vulnerable patients and their families,” she added.