ReSPECT form completion - A quality improvement project reviewing the accuracy and completeness of ReSPECT form documentation and DNACPR decisions

Background:

Clear and accurate documentation of a Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision is vital to ensure patients receive appropriate care and autonomy regarding their end-of-life management. Inaccuracies or omissions allow potential for unnecessary or harmful interventions to occur.

Aims/Objectives:

To produce ≥20% improvement in accuracy and overall completion of all sections of respiratory inpatient ReSPECT forms, with particular focus on DNACPR decisions, during a four-month respiratory placement. 

Methods:

Between 21/12/21-29/4/22, DRI inpatient ReSPECT forms were reviewed for completion and accuracy overall and for individual subsections. After two weeks’ pre-intervention data collection, three interventions with complete PDSA cycles (junior presentation, ward posters and emailed consultant presentation) were implemented over 11 data collection points. Interventions reminded doctors to review forms and identify/rectify errors.

Results:

Name documentation showed a 5% sustained improvement. Consultant countersignature completion improved from baseline over seven consecutive data timepoints but wasn’t sustained long-term. No intervention significantly improved overall form completeness and patient preferences remained poorly completed (all ≤30%). 100% documentation of DNACPR status at baseline was sustained throughout. However, discussion details remained poorly documented without significant improvements seen.

Conclusions:

Despite some minor improvements seen, no intervention produced sustained changes to overall completion or key sub-sections. Sample size and project duration are recognized limitations. However, these null results emphasize that current forms are not utilized as intended and that ReSPECT completion could be significantly improved. Findings have contributed to wider research by Palliative and Resuscitation teams.