EXCLUSIVE

The Law Officers’ Department was called into the Hospital to deliver legal training to clinicians about ‘do not resuscitate’ forms after an audit identified gaps in understanding of the consent and documentation required for these life-and-death decisions, Express has learned.

Express revealed earlier this year that the Serious Incident Review Panel commissioned an “urgent audit” of compliance with paperwork following concerns around DNACPR.

DNACPR stands for ‘do not attempt cardiopulmonary resuscitation’. This means if a patient’s heart or breathing stops, their healthcare team will not try to restart it.

Some people make a DNACPR decision simply because they do not want to be resuscitated in an emergency. Others make the decision along with their health care provider, after experiencing health issues that might inform their decision.

In some instances, healthcare teams may have to make decisions on behalf of patients. This might happen because a patient is so unwell from an underlying illness, that CPR will not prevent their death.

Express requested a copy of the DNACPR audit under the Freedom of Information Law at the start of June, and did not receive a response until the end of August.

The audit, carried out in June 2024, identified shortcomings in how DNACPR decisions are documented and communicated to patients and families.

The 48-hour review examined almost 100 DNACPR forms across multiple wards and services within the Health Department.

It found that 45% of DNACPR decisions had not involved discussion with the patient. In some cases, patients with capacity were not consulted about the decision.

Almost a third of DNACPR decisions had not involved discussion with “important individuals” such as family members.

The audit also uncovered problems with record-keeping. Almost half of the audited DNACPR forms were not uploaded to the electronic patient records system Maxims due to a lack of scanners, reliance on a single night-shift staff member, or staff stating “we don’t use Maxims”.

The audit also reported that 66% of patients that lacked capacity had a Significant Restriction of Liberty (SROL) order in place.

SRoL orders are a safeguard for people who lack capacity to consent to the arrangements for their care and treatment in some settings.

This generally means that the patient does not have the capacity to agree to be in hospital, a care home, or supported living, but needs to be there to receive treatment or care.

The audit found that 17% of patients who lacked capacity to consent to care had no SRoL order, and a further 17% were left waiting for a response – with some applications dating back to January.

As a result of the findings, resuscitation staff were asked to brief foundation doctors to clarify their responsibilities in completing DNACPR documentation.

As a result of this report, a number of actions were identified and put in place at the time.

The Law Officers’ Department were invited to deliver legal training on DNACPR, which has since been reinforced during essential training days for clinical staff.

A further review of this training is planned in the next two months.

In the first quarter of this year, 93% of DNACPR forms were signed by a consultant. In the second quarter of this year, this rose to 98.3%.