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'When we see a patient’s condition deteriorating, the instinct to save usually kicks in'

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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.

  • Comments (2)

Readers' comments (2)

  • michael stone

    Good to see that Ann has (presumably) read the NCEPOD report - but the report did not address the deeper problems surrounding who makes decisions.

    It did comment that 7 patients who were on end-of-life pathways, had attempted CPR - somewhat remarkably, resuscitation 'worked' in 6 out of 7 cases, but the authors found it difficult to conceive of circumstances under which attempted CPR might benefit a patient who is on an eol pathway (I can't answer that one, either: I can see how a patient who has requested CPR even if it probably wouldn't work, might othewise be on an eol pathway - but presumably it would be 'attempt CPR and give active treatments for other problems as well' {for example, a patient who was still trying to finalise his Will, or whose daughter was desperately trying to get home from abroad to 'say goodbye'}).

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  • Mike Stone
    I would very much doubt the legality of a death-bed Will, it would be far too easy to challenge its outcome. No medic in the land would resuscitate a dying patient just so a relative flying in from their holidays can say goodbye.
    The Care of the Dying pathway is that-it's for those who are dying ( granted, there are always tales of miraculous returns to health, which is why it has changed to include regular turns and the like), the people on it can be for active treatment for symptomatic relief, but they should have a CLEARLY documented DNAR slip in their casenotes ( I very much suspect that that is what did not happen to these unfortunates who were resuscitated)

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