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ReSPECT Level 2: Action

ReSPECT Level 2: Action
Training for staff who will need to recognise the form, and act on the recommendations.

  • As ReSPECT Level 1: Awareness plus:
  • How to care for someone with a ReSPECT form
  • During an emergency where a person is unable to make or express choices
  • When to update the form

ReSPECT Level 2 builds upon the training at Level 1, which should be completed first.

Contact us for access to our implementation workspace which includes:

  • Master training slides for all levels of training (PPT)
  • Trainers’ handbook with reference information (PDF)
  • Guidance for clinical staff editable versions for local adaptation (PPT)
  • Training needs analysis (Word)
  • Printable blank ReSPECT forms and editable PDF forms

Training resources have been developed based on resources produced by the Resuscitation Council and early implementers. We are very grateful to colleagues in Sussex, NHS Forth Valley, Lincolnshire and Worcestershire who have shared their learning and resources with us.

How to care for someone with a ReSPECT form?

The Resuscitation Council have identified two situations where the ReSPECT process is key:

  1. During an emergency where a person is unable to make or express choices.
  2. In an non-emergency situation, when the recommendations may need to be reviewed and, if necessary, updated or cancelled.

A ReSPECT form does not always mean DNACPR. You must get in the habit of looking into both boxes on the form to see which applies. 

Existing DNACPR forms will still be valid and will not be replaced unless there is a change in condition.

If the patient has two forms which one is valid? The most recent form, whether DNACPR or ReSPECT will be valid. Older forms should be crossed through with CANCELLED written on them before filing in patient records.

During an emergency where a person is unable to make or express choices

The process to follow, as set out in the national ReSPECT e-learning is Confirm — Read — Act:

  • Confirm the identity of the person and that it is the latest version of the form for that person.
  • Read the form to understand which recommendations may relate to your role in their care.
  • If the recommendations apply to the current emergency and the person cannot decide for themselves then act on the recommendations relevant to your role when caring for that person.

If a situation arises that is not addressed on the form, or staff are unsure what to do, they should ask for help from their seniors, or members of the clinical team.

If a patient is at risk of deterioration, using a National Early Warning Score (NEWS2) can be used to communicate a summary of a patient’s condition, escalation of care, or referral as required. Download our NEWS2 quick reference card.

When communicating critical information that requires immediate attention or action, SBAR (situation, background, assessment, recommendation) can aid in information exchange. Download our SBAR quick reference cards.

Further reading:

When to update the form

The form may be updated when the person (or their representative) asks for this, when there has been a significant change in the person’s condition, and when the person is moving (or has moved) from one setting to another (such as from home to hospital).

Existing DNACPR forms will continue to be valid and will be recognised by all organisations as before and do not need to be replaced immediately. When reviewing a DNACPR form, it may be appropriate to replace this with a ReSPECT form.

ReSPECT forms that are no longer valid should be clearly marked “CANCELLED” with two diagonal lines, your legible signature (and legible name and registration number) and the date). Once the recommendations are updated share the information with relevant health and social care staff involved in the person’s care.

Find out more about communicating the form in our Level 3 training.

Additional guidance for specific settings

Watch case studies from Worcestershire:

Case Study one:   Emergency active treatment (two minutes)

  • A ReSPECT form does not always mean that resuscitation is not recommended
  • In an emergency situation, when no ReSPECT form is available, life-saving treatment should be given if considered to be in the best interest of the patient.
  • ReSPECT from can be used to consider organ donation preferences
  • For patients without capacity, the best interest decision making process should be followed when completing ReSPECT forms.
  • All assessments of mental capacity where specific decisions need to be made regarding care & treatment and/or DNACPR should be recorded on the MCA 1
  • All best interests decisions made regarding care & treatment and/or DNACPR should be recorded on the MCA 2 form
  • ReSPECT can be initiated in any care setting including the Emergency Department
  • ReSPECT can be used to record DNACPR recommendations
  • There should be a presumption in favour of patient involvement [in the DNACPR decision]. There needs to be convincing reasons not to involve the patient’.Tracey vs Cambridge University Hospital NHS FT (2015)
  • ReSPECT is complementary to other advance care planning initiatives, such as Advance Care Plans & AMBER care Bundle that is used for patients in hospital with uncertain recovery
  • ReSPECT is a patient held form & must travel with the patient & be reviewed upon a change of setting or condition.
  • ReSPECT forms can help patients to prioritise their preferences for care & treatment and agree realistic clinical recommendations and ceilings of medical intervention.
  • ReSPECT forms should sign post to other documents such as Advance Care Plans & Advanced Decisions to Refuse Treatments
  • ReSPECT can be used to outline preferences for place of care for medical treatment and place of death but also recognises these are ‘preferences’ not absolute.
  • ReSPECT forms can be effectively utilised for patients living with chronic illnesses for emergency care planning.

How to care for someone with a ReSPECT form in an emergency — ambulance services:

How to care for someone with a ReSPECT form in an emergency — emergency departments

How to care for someone with a ReSPECT form in the hospital

ReSPECT can be complementary to any wider process of advance or anticipatory care planning.

Within acute hospitals in the West of England, trusts have agreed that they will use the ReSPECT form as a summary to complement inpatient treatment escalation plans (TEPs) which may be more detailed to reflect an individual’s clinical circumstances.

How to care for someone with a ReSPECT form in a care or nursing home

Within care homes in the West of England, some care homes are part of our SAFER care collaborative (Safety & Autonomy For Every Resident) where we are implementing the RESTORE2 deteriorating resident tool for care and nursing home. RESTORE2 is a physical deterioration and escalation tool incorporating the ReSPECT process, recognising the softer signs of resident deterioration, taking physical observations to calculate a NEWS2 (National Early Warning Score), escalating to the right healthcare professional for clinical support, and using the SBARD (situation, background, assessment, recommendation, decision) tool to concisely communicate the message. RESTORE2 was developed by Hampshire, Southampton and Isle of Wight CCG. Read more about the RESTORE2 here. 

Health Education Kent, Surrey and Sussex have developed a free online training course for care home staff and HCAs (health care assistants) to equip staff with the knowledge and skills needed to start discussing the concerns, preferences and wishes of patients, residents or other users of health and social care, spotting the potential verbal cues that a person may be open to a ReSPECT process conversation and alert a senior member of the team that a conversation may be further developed with this person. Access Health Education Kent, Surrey and Sussex’s free online training course for care home staff and HCAs. 

ReSPECT in your area

ReSPECT is being implemented across the West of England. Links to sources of local information:

Bristol, North Somerset and South Gloucestershire
For healthcare professionals – BNSSG CCG
St Peter’s Hospice clinical guidelines
For members of the public in Gloucestershire
For healthcare professionals in Gloucestershire 
Bath and North East Somerset, Swindon and Wiltshire

Once you have completed Level 2 : Action carry on to Level 3 : Conversations

Click here to go back to Level 1 :  Awareness