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A study released by the UK’s Care Quality Commission (CQC) on Thursday reported that more than 500 people in the UK have been placed on ‘no resuscitation’ orders without their or caregivers’ consent during the coronavirus pandemic.

“Since the start of the COVID-19 pandemic, there have been concerns that decisions to“ not attempt cardiopulmonary resuscitation ”(DNACPR) were taken without involving persons or their families and / or caregivers if they wished to do so, and were being applied to groups of people, rather than Take into account the individual circumstances of each person, “according to a study by the Independent Health and Social Care Regulator in England.

Of the 2,048 adult social care providers who responded to the CQC Information Request, 5.2% (508 of 9,679) DNACPR decisions made since March 17, 2020 “have not been agreed upon in discussion with the person or their relative or caregiver,” The study said.

The report includes at least one case study of a man whose death may have involved a mandatory non-resuscitation order.

“Jim, who was in his 80s, was taken to hospital at the start of the epidemic after he became unwell with a chest infection. The report said that Jim, who still works, was usually in good shape and activity and had been out in his car most weeks to visit Friends or going to the movies.
About 12 hours after he was hospitalized, Jim called [his daughter] Melanie. Upset and confused, he told her that he had fallen alive and he would die. He told her that a doctor has ordered that his heart not restart if it stops. He was upset that he agreed to it because he did not want to die. “
The daughter told the committee that she had tried to speak to the medical and nursing staff about the decision.
“Because Jim was able to make decisions about his care, no one discussed the decision with her,” she said, according to the report. “However, she was worried that her father was weak because he was sick, and was likely confused because he had a bad infection, and he was alone. I felt like he was going to go with what they told him.”
“Jim died while in hospital,” the report said.

The report is the result of a request from the Department of Health and Welfare to the CQC to conduct a “rapid review of how DNACPR decisions have been used during the coronavirus pandemic, based on concerns that they have been applied inappropriately to groups of people without their knowledge.”

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“It is unacceptable for any DNACPR decisions to be made without appropriate conversations with the appropriate individual or representative, taking into account their wishes and needs,” the report said.

An interim report from the CQC in November 2020 revealed that “a combination of unprecedented pressure on caregivers and rapidly evolving mentoring may have led to decisions regarding DNACPR that were incorrectly confused with other clinical evaluations about critical care,” the CQC said.

Despite positive feedback from most caregivers, the CQC revealed some concerns about the use of the proposed “blanket” DNACPR decisions at the local level.

“Throughout the review process, while inspectors found some examples of good practice, they also found a disturbing picture of poor participation of people using the services, poor record keeping, and a lack of oversight and scrutiny in decisions made,” the study said.

The CQC called for government action to address the “disturbing difference” in people’s experiences of DNACPR decisions and to “take responsibility for making improvements in this vital and sensitive area.”

She said that CQC’s goal by appealing to ministers is to focus more on “information, training and support,” as well as “a coherent national approach to advanced care planning” and “improving supervision and assurance”.

Correction: A previous version of this post incorrectly mentioned the release date of the CQC Interim Report.

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