Blanket ‘Do Not Resuscitate’ Orders Possibly Used Amid Pandemic: Care Watchdog

Medical staff wearing full PPE (personal protective equipment) treat a patient with the CCP virus on an Intensive Care Unit at Frimley Park Hospital in Frimley, southwest England, on May 22, 2020. Steve Parsons/Pool/AFP via Getty Images

Patients in England may have been subject to blanket decisions not to resuscitate them during the first wave of the CCP virus pandemic, the country’s care watchdog has revealed.

The group orders not to resuscitate could have been used due to high pressure on health and care services at the start of the virus crisis, the Care Quality Commission (CQC) said in an interim report (pdf) released on Thursday.

Normally, Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders, commonly known as Do Not Resuscitate (DNR) orders, must only be applied following a “person-centred” assessment of an individual’s specific circumstances that involves the person themselves.

But the CQC said there was “confusion and miscommunication about the application of DNACPRs at the start of the pandemic and a sense of providers being overwhelmed.”

It said that though there was now “no evidence to suggest that it [the inappropriate use of DNRs] has continued as a widespread problem,” there remained “differing views on the extent to which people are now experiencing positive person-centred care and support in relation to this issue.”

The CQC said that some suspect DNR orders may still be in use.

“We expect all care providers to assure themselves that any DNACPR decisions have been made appropriately, in discussion with the person, and in line with legal requirements and best practice,” it added.

National Concern

Responding to the CQC’s interim report, NHS England said in an emailed statement: “The NHS has repeatedly instructed local services, clinicians, and managers, that the blanket application of DNRs is totally unacceptable.”

The interim report is a special commission made by the Department for Health and Social Care after concerns were raised nationally in a “quick response from multiple agencies to highlight the issue,” the CQC said.

The watchdog said it aims to further track the scale of the concern around the improper application of DNRs during the pandemic.

It said it would look at how they were used in prior care-planning for the meeting of patient needs in the event that they become seriously ill, taking into account human rights and those most at risk of neglect and discrimination.

“Care and support should always be delivered in a person-centred way,” it said.

“Advance care planning is no exception: the COVID-19 pandemic does not give permission for people’s expectations to be diluted or ignored,” it added.

The CQC said it will publish its final, more detailed, report in February.