Do not resuscitate orders might have been put in place without consent, watchdog says

Patients may have been under inappropriate “do not resuscitate orders” by doctors making blanket decisions during the first wave of the pandemic, the care watchdog has said.

Complaints about do not attempt cardiopulmonary resuscitation (DNACPR) orders jumped to 40 between March and September, compared with nine in the previous six months, the Care Quality Commission (CQC) said.

An investigation by the CQC has found DNACPRs may have been used inappropriately as care services were under extreme pressure and had misunderstood guidance on their use.

In one case, a carer said an on-call doctor had told care home staff that any resident who caught COVID-19 would have a DNACPR order put in place.

Another witness said some care homes and learning disability services were told by GPs to place blanket orders on everyone in their care.

The resuscitation procedure can cause punctured lungs, fractured ribs and severe bruising, and only 15 to 20% of people survive it in hospital.

Outside of a hospital setting, survival rates drop to between 5 to 10%.

But CQC guidance states failing to offer all options to patients and their families is a breach of their human rights, and that blanket decisions must never be made on DNACPRs.

The watchdog said it had received evidence from staff and patients’ families that some orders had been applied without consultation.

In some cases, families were not aware the order was in place until their relative became unwell.

Others said they had been told their loved one agreed to a DNACPR order, but they were concerned there had been a misunderstanding because of factors such as a language barrier or deafness.

The CQC said there were also examples of routine care not being provided in homes, such as an ambulance or doctor not being called, because of a DNACPR order that was in place.

The watchdog has warned inappropriate DNACPR orders could still be in place for some people.

Rosie Benneyworth, chief inspector of primary medical services and integrated care at the CQC, said: “It is unacceptable for clinical decisions – decisions which could dictate whether someone’s loved one gets the right care when they need it most – to be applied in a blanket approach to any group of people.”

An NHS spokeswoman said: “The NHS has repeatedly instructed local clinicians that the blanket application of DNRs would be totally unacceptable and that access to treatment and care for people with learning disabilities and autism should always be made on an individual basis and in consultation with family and carers.”

(c) Sky News 2020: Do not resuscitate orders might have been put in place without consent, watchdog says