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ReSPECT

ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) is a process to plan a person’s clinical care in the event of a future emergency in which they are unable to make or express choices.

ReSPECT can be for anyone who wants to record their care and treatment preferences, but particularly those who have complex health needs, are likely to be nearing the end of life, or at risk of sudden deterioration or cardiac arrest. Find out more about the ReSPECT process.

We are implementing the ReSPECT process across the West of England to encourage people to have conversations about advance care planning.

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What are we doing in the West of England?

The aim of the project is to understand whether the ReSPECT process offers confidence and an effective framework for encouraging and empowering staff to have these important conversations with their patients. As a result, we aim to explore and identify barriers to supporting patient’s wishes as documented on a ReSPECT form from an organisational, system and cultural perspective.

ReSPECT has been developed by the UK Resuscitation Council. It is currently being implemented in various locations across the country.

Too few of our most frail and complex patients have advance care plans that describe what should happen in an emergency. This means that clinicians and carers have to make decisions about a person’s best interests and preferences and some very frail patients are resuscitated when they would not wish to be.

Many people are also taken to hospital in an emergency when they would have preferred to stay at home. They often recover much more slowly in hospital than they would have in more familiar surroundings.

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 greater satisfaction for staff who can be confident they are following their patients’ wishes.

The rollout 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 by improving the reliability in the three main domains within deterioration underpinned by excellent communication between professionals and with patients.

  • Recognition: The expedient recognition of deterioration through reliable monitoring, identification and assessment of all patients’ conditions in all environments.
  • Response: the reliable activation, timely response and communication of deterioration.
  • Escalation: the reliable escalation and de-escalation of clinical interventions and review by senior clinicians, to include advance care planning to reduce inappropriate care.

The process is that trained staff guide selected patients through an extended conversation, often taking place over a number of contacts to allow families and carers to be involved. The process results in a completed ReSPECT form that details the person’s wishes for their care, along with appropriate clinical recommendations.

It will also record a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision if one has been made. However, ReSPECT is about much wider care preferences and treatment ceilings and is equally applicable to patients for whom resuscitation is appropriate.

If you’d like to get involved in this work, email us at ps@weahsn.net

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What is ReSPECT?

ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) is a process to plan a person’s clinical care in the event of a future emergency in which they are unable to make or express choices.

The process is that trained staff guide selected patients through an extended conversation, often taking place over a number of contacts to allow families and carers to be involved. The process results in a completed ReSPECT form that details the person’s wishes for their care, along with appropriate clinical recommendations.

It will also record a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision if one has been made. However, ReSPECT is about much wider care preferences and treatment ceilings and is equally applicable to patients for whom resuscitation is appropriate.

Image of a ReSPECT form

The ReSPECT process page for healthcare professionals has a wealth of resources including:

The ReSPECT Learning Web-application developed by UCL partners in partnership with Macmillan, RCN Foundation, Resuscitation Council and Imperial College London, can be downloaded and used on mobile devices as well as desktop computers. The app allows you to learn about the ReSPECT process and how it applies to you. The content has been primarily designed for use by people of all disciplines working in health and social care, but is also available for members of the public. When you log in, you can select your role to make sure that the content is relevant to you.

Within the app, you can learn about what the ReSPECT process is, who ReSPECT is for, having a conversation about ReSPECT, practicalities of the ReSPECT form, and how to care for someone with a ReSPECT form. There are a variety of different ways to use the app; information is presented as modules with animations and podcasts, as well as clinical scenarios to assess your understanding and practical tools to enable you to reflect on your practice.

#TalkCPR

Talking about Do Not Attempt CardioPulmonary Resuscitation (DNACPR) is an important part of advance care planning and can help minimise distress at a later stage. NHS Wales have produced a number of very useful videos for healthcare professionals and patients to encourage conversation about CardioPulmonary Resuscitation (CPR) for people affected by life-limiting and palliative illnesses. #TalkCPR tweets

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Useful resources

Share a useful resource you have found with us to add to this page.

Share a resource you have found helpful with a colleague.

Listen to the Radio 4 “We Need to Talk About Death” programme aired on 9 January 2019.

Listen to this 50 minute MDTea podcast on advance care planning (and read the show notes).

Read Being Mortal by Atul Gawande or  With the End in Mind by Katherine Mannix.

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Learning from Deaths

Our focus on ReSPECT has evolved from our work on Structured Mortality Reviews and the national Learning from Deaths programme which has highlighted the need for appropriate care planning as patients approach the end of their life. In partnership with eight acute trusts, we are one of the early implementers of the Royal College of Physicians’ Structured Mortality Review process, and have developed a best practice framework as a template to support trusts in adopting this approach.

Across the West of England we support a culture which enables open and honest conversations and sharing data for improvement and learning. Find out more at www.weahsn.net/structured-mortality-reviews.

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Previous events

7 June event report

17 October 2018 event report

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