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ReSPECT Level 3: Conversations

ReSPECT Level 3: Conversations
Training for staff who will be initiating or carrying out conversations with patients and their families about treatment escalation, DNACPR, and the ReSPECT process.

  • As ReSPECT Level 1 and Level 2 plus
  • Having a conversation about ReSPECT
  • Completing the form
  • Communicating the form
  • The ReSPECT form, legal status and relationship with other areas

ReSPECT Level 3 builds upon the training at Levels 1 and 2, which should be completed first.

Please 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.

Having a conversation about ReSPECT

Any healthcare professional who is suitably trained and experienced can complete the form, in close liaison with the patient or their legal advocate.

Identifying patients who may benefit from a ReSPECT conversation

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.

There are some triggers that may prompt healthcare professionals to consider initiating a ReSPECT conversation:

  • A new diagnosis of a serious life-limiting condition whether in hospital or primary care.
  • People who were otherwise well who have deteriorated suddenly, particularly those over the age of 85 with two or more emergency attendances / admissions in a six month period, identified by Emergency Department or paramedics.
  • People over the age of 65 who have been identified as living with moderate or severe frailty, for example through use of the Electronic Frailty Index (eFI) by GPs or SPICT tool.
  • People with a chronic condition identified with poor prognostic markers for their condition and therefore may be in the last year of life, for example identified through a poor prognosis letter (PPL) from hospitals to GPs.

Normalising the conversation. Consider asking “Do you have an advanced care plan?” at every admission as part of your clerking process.

The following triggers have been identified by NHS Forth Valley for prioritising emergency/ anticipatory care planning in a hospital setting:

  • Life limiting condition
  • Care home resident
  • Identified risk of acute deterioration, cardiac arrest or death including increasing NEWS2
  • All patients with NEWS2>7
  • Request by the individual/ family to record preferences
  • Long term/ complex health needs
  • Recurrent admissions

In a pilot in NHS Forth Valley, 63% of patients in an older adult acute medical ward screened using these triggers were identified as having one or more triggers.

ReSPECT can be used for any age (with appropriate parental involvement for children and young people) however in the first instance in the West of England AHSN region our focus is on adult patients. A ReSPECT compatible Advanced Care Plan is available for Children and Young Persons.

Initiating a discussion about ReSPECT

  • Watch this five minute video on Communication Skills from Worcestershire

ReSPECT can be used for any age (with appropriate parental involvement for children and young people) however in the first instance in the West of England AHSN region our focus is on adult patients. Information on ReSPECT for young people and parents is available on the ReSPECT process website.

#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.

You can review the #TalkCPR tweets here

Further reading:

Completing the form

How to check if a ReSPECT form has been filled in correctly

Communicating the form

Once a ReSPECT form is completed by a senior clinician (doctor or nurse), and has been countersigned (if appropriate), it is their responsibility to inform the wider health team.

Once a form is completed, it is important that the person keeps it with them, and that it is readily available for professionals who may need to see and use it.

Templates are available for EMIS and SystemOne as well as printable and editable PDF versions. Please contact us for access. 

ReSPECT is a paper patient held record. This is also the case for the existing DNACPR form. The national ReSPECT Working Group is committed to the development of a digitised version of ReSPECT. It should be noted that no time frame has yet been set for this and therefore areas across the country have not delayed their adoption of ReSPECT on this basis.

For more information on the digital implementation of ReSPECT in the West of England read our output report from our 20 March 2019 event.

The ReSPECT form, legal status and relationship with other areas

For more information on the legal status of ReSPECT in the West of England read our PDF output report from our 20 March 2019 event and FAQ from the Resus Council.


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