Posted on February 18, 2022
The ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) process creates a summary of personalised recommendations for a person’s clinical care in a future emergency in which they do not have capacity to make or express choices. ReSPECT was developed by the Resuscitation Council, working alongside NHS stakeholders, patients, and families.
The roll-out of ReSPECT in the West of England is one part of a national Patient Safety Collaborative strategy to improve the care of patients at risk of deterioration. The West of England AHSN worked to ensure three local systems aligned to use and spread the same process. ReSPECT was implemented in Bristol, North Somerset and South Gloucestershire (BNSSG) and Gloucestershire Integrated Care Systems (ICS) at the end of 2019, and is now well embedded in services across both regions, with Bath and North East Somerset, Swindon and Wiltshire (BSW) ICS implementing ReSPECT in October 2021.
Our programme to support the use of ReSPECT evolved from insights gained through the ED Collaborative, and roll out of the ED Safety Checklist and NEWS2, around inappropriate end of life ED attendance and conveyance, alongside our wider work around Structured Mortality Reviews.
Ensuring there are high-quality advance care plans, accessible to the clinicians who need them, enables better care for patients, peace of mind for their carers and reassurance for staff who can be confident they are following their patients’ wishes.
Before the start of this project, frail and complex patients might have a do not resuscitate form or treatment escalation plan but few had advance care plans describing what should happen in an emergency. This meant that clinicians and carers had to make decisions about a person’s best interests and preferences and rarely very frail patients were resuscitated against their wishes.
In 2018, there was a mixed picture across the region for managing end of life and emergency care. The West of England AHSN aimed to create a unified system to make these challenging conversations easier and ensure a person’s wishes were recorded and easily accessible to health care workers in an emergency.
The aim of the project in the West of England was also to make sure the ReSPECT process offered confidence and an effective framework for encouraging and empowering staff when having these important conversations with their patients.
The West of England AHSN invited the Resuscitation Council to introduce ReSPECT to the region in June 2018. Delegates from 54 organisations attended the ‘Exploring approaches to end-of-life care’ event. Following the event Gloucestershire and BNSSG ICSs, agreed to implement ReSPECT together.
In October 2018 and March 2019, the West of England AHSN held learning and sharing events to prepare for the joint launch in October 2019. The launch covered a population of 1.6 million people, including primary care, four acute trusts, four community healthcare providers, one mental health trust, the ambulance service, hospices and voluntary organisations.
The COVID-19 pandemic brought with it extra resonance for the ReSPECT programme. During the pandemic, registered nurses in nursing homes received online ReSPECT conversation training sessions and so they were able to have individualised ReSPECT conversations and complete forms for residents unable to see their GP. A training package was also created for RESTORE2 and developed for care homes which included awareness of ReSPECT. This package has so far been delivered to 2,375 care home workers from 255 care providers by the West of England AHSN.
In September 2021, One Gloucestershire and the AHSN ran online learning sessions for paramedics in the West of England to help them to better use and understand the ReSPECT process.
The West of England AHSN has continued advocacy of ReSPECT, with BSW ICS implementing ReSPECT in October 2021.
The ReSPECT process was amended to reflect use during the COVID-19 pandemic.
The AHSN created a suite of resources for healthcare systems including implementation and training toolkits. The AHSN has also worked with the Resuscitation Council UK to produce two animations, one for patients and the public and one for healthcare professionals, telling the story of Joe and how his ReSPECT form improved communication and coordinated personalised, individualised care across the health and care system.
“What has been incredible is how the whole of the health and social care community within Gloucestershire have come together and driven this project. The cross boundary working, shared learning and respect literally for each other’s roles has been really fantastic to see.”
A social care provider in Gloucestershire
Impacts to date
Impacts for the project relate to quality of care and relationships built between organisations. The implementation standardised multiple processes reducing duplication, improved access to information, and encouraged earlier conversations with individuals and families. The project was not intended to save money, however it was cost effective as substituting one process with another required no financial investment; apart from events and project management funded by the West of England AHSN.
15,000 ReSPECT forms have been completed across the region (to September 2021).
A unique output from this project was a digital ReSPECT template created by a local GP and approved by the Resuscitation Council. The South West CIO network successfully lobbied for an opt-out policy for additional information in the Summary Care Record , which was implemented during COVID-19 allowing ReSPECT decisions to be visible digitally to South West Ambulance Service first responders.
The AHSN also set up an online workspace on the FutureNHS collaboration platform to share resources and learning.
“I can’t remember the last time I’ve had to flick through the notes of a deteriorating patient urgently searching for discussions about treatment escalation recommendations. Now I can just find the decisions easily at the front of the clinical records and give the patient the care that the team who knows them best, has agreed.”
A nurse practitioner
After the successful adoption and spread of ReSPECT, the West of England AHSN are conducting a qualitative evaluation of the ReSPECT process in care homes in collaboration with the Applied Research Collaborative (ARC) West.
ReSPECT continues to inform our patient safety work to manage deterioration and support care homes. For instance, the West of England Learning Disabilities Collaborative continues to advocate use of ReSPECT and the AHSN now offers free training to care providers to detect and respond to the soft signs of deterioration alongside the importance of advance care planning.
Our involvement in the ReSPECT project started in 2018 and is ongoing.