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Care homes guilty of DNACPR ‘mission creep’

Care home residents were denied access to hospital treatment because of the incorrect use of Do Not Attempt CPR recommendations, according to Essex researchers.

Researchers have published evidence that in 2021 Do Not Attempt CPR (DNACPR) recommendations influenced healthcare decisions outside their intended remit.

“Some residents are being inappropriately denied transfer to hospital or access to certain medicines. The best way to describe it is a form of ‘mission creep’ of DNACPR recommendations being used beyond their intended remit,” said Principal Investigator Professor Wayne Martin.

The findings, Managing DNACPR Decisions in Residential Care: Towards Improved Training for Social Care and Capacity Professionals are published in the British Journal of Social Work. These show that over half of respondents (56 per cent) reported new DNACPR decisions being recorded during the pandemic; 55 per cent reported witnessing orders being added without consultation with the resident or family; and 28 per cent reported DNACPR orders being added because of blanket decisions based on characteristics such as age.

Additionally, 17 per cent of respondents (44) reported that they had witnessed DNACPR recommendations informing care and treatment decisions beyond cardiopulmonary resuscitation. More than half reported that DNACPR recommendations were made without consulting with the individual or their families.

The online survey of professionals working in care homes in England was conducted by the Essex Autonomy Project in 2021. Researchers also cite widespread confusion among professionals about the meaning and legal status of DNACPR recommendations: most wrongly believe that DNACPR recommendations are legally binding.

In follow-up focus groups, one participant reported: “Some staff see ‘DNR’ as ‘do not care’, or ‘do not seek any medical treatment’,” researchers added.

Professor Martin’s research group is calling for urgent reform of the process for making DNACPR recommendations, including revisions to the DNACPR forms used in England and Wales, and to implement new standards, guidance and training for social work and capacity professionals.

Professor Martin said: “It’s clear from pre- and post-pandemic cases… that this was not a problem created by COVID and that it requires urgent attention.”  

The survey was completed by 262 care professionals most of whom had responsibility for applying the Mental Capacity Act 2005.


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