21.08.14
NHS England to review DNR question on care plans
NHS England has agreed to review controversial guidelines that instruct nurses to ask elderly patients whether they would agree to a do not resuscitate (DNR) order.
The document – Avoiding unplanned admissions enhanced service: Proactive case finding and care review for vulnerable people – is intended to help GPs, nurses and other health and care staff develop personalised care plans with those who are most vulnerable and have complex health and care needs.
However, media reports this week have shown that in some cases patients were visited by district nurses they have never met before, and were asked sensitive questions. These included where they want to die, and if they want doctors to try to resuscitate them should their hearts stop.
Health commentator Roy Lilley – who was at his mother’s house when a nurse visited to carry out a care plan – described the policy as ‘callous’ and called for it to be banned.
Following the criticism of the policy, NHS England’s chief nursing officer Jane Cummings said: “I spoke to Roy Lilley, who described the experience his mother had. It was not good, upsetting and should not have happened. As a nurse I was very disappointed to hear that story.”
However, she went on to say that there are thousands of great district and community nurses delivering compassionate care in a wide range of environments every day.
“They would never dream of asking patients where and how they would like to die in an insensitive or bureaucratic way,” she said.
With regards to the policy and the DNR question, Cummings said there is one question on the form relating to emergency care and treatment and it mentions resuscitation as a possible discussion point.
“Clearly if this conversation is appropriate for the patient, and as the form suggests it might not be, then it should be handled with great care,” she said. “We will review the form again, with patients and clinical staff, in the light of the poor experiences described in the media and make any changes that are needed.”
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