The only way health professionals can be sure of spotting it is if initial assessment on admission is thorough, and is repeated at appropriate intervals. It is also important that all members of the healthcare team are clear about what treatments or interventions are appropriate.
The latest publication from the National Confidential Enquiry into Patient Outcome and Death reports on the care received by patients who received CPR after a cardiac arrest in hospital. NCEPOD found that in almost half of cases the patient’s initial assessment was deficient, and that senior doctors were not involved in managing many of the patients.
While a variety of reports have made recommendations on how to respond to patient deterioration, this one also identified the need to focus on those patients whose best interest may not be served by initiating CPR or life-prolonging treatment. This may be the case even in patients who are receiving active treatment to try to improve their condition.
When health professionals see a patient’s condition deteriorating, the instinct to save usually kicks in. However, when patients are dying, CPR is inappropriate and can make their last hours painful, distressing and undignified.
Thorough initial assessment of acutely ill patients is crucial, but should also include assessment of whether or not this patient should be resuscitated in the event of cardiac arrest. Of course decisions not to attempt CPR should not be taken lightly. They must involve senior doctors and, if possible, the patient and/or next of kin - which must be done with care and sensitivity. Once taken, however, DNACPR decisions must also be respected.
Acutely ill patients are extremely vulnerable if their condition deteriorates. They deserve thorough assessment and observation to ensure the care they receive is appropriate to them - and sometimes that means stepping back, keeping them comfortable and letting nature take its course.