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Do-Not-Resuscitate Order: Care Home Use Reviewed

October 14, 2020

The use of do-not-attempt-resuscitate (DNAR) orders is to be reviewed after a number were wrongly applied in care homes at the start of the pandemic.

The Care Quality Commission (CQC) will investigate concerns that some care homes still have blanket orders in place covering groups of residents.

It became clear that blanket use was in place in some care homes in the early weeks of the pandemic.

But it was widely condemned by the CQC and medical bodies.

The decision about whether or not to attempt resuscitation if a very sick person falls dangerously ill is supposed to be discussed with the individual, or family members if they are too sick.

Doctors can make a decision on the spot without consultation in exceptional circumstances.

However, the decisions are always supposed to be made on an individual case-by-case basis.

The health minister Lord Bethell has asked the CQC to investigate the latest claims. He told the House of Lords that blanket use of DNARs was “unacceptable”.

Extraordinary pressures

Dr Rosie Benneyworth, CQC chief inspector of primary medical services and integrated care, said: “Health and social care providers have faced extraordinary pressures this year. Both staff, and people using services and their loved ones, have at times raised concerns with us about care.

“It is vital that we take this opportunity to learn from what has happened – challenging poor care and sharing the ways that providers have put people’s needs at the heart of their care so that others can learn from them.”

Dr Benneyworth said it was unacceptable for DNARs to be applied to groups of people of any description.

“These decisions must continue to be made on an individual basis according to need. Through this review we will look to identify and share best practice in this complex area, as well as identifying where decisions may not have been patient-centred, and ensuring mistakes are not repeated.”

NHS England said it had already made clear that orders should only ever be made on an individual basis.

The charity Pohwer said it had found blanket DNARs put in place across Norfolk, West Midlands, London, Oxfordshire, Sussex, Surrey and Buckinghamshire, potentially affecting more than 700 people.

In a statement, the charity said: “There are probably many more cases where the homes did not necessarily admit to the blanket DNAR order, or where they did not feel comfortable speaking with an external organisation. So 704 is the minimum number of individuals that would have otherwise been affected.”

Last week Amnesty International said sending thousands of older untested patients into care homes in England at the start of the coronavirus lockdown was a violation of their human rights.

More than 18,000 people living in care homes died with Covid-19, and Amnesty says the public inquiry promised by the government must begin immediately, including a thorough review of the use of DNAR forms.

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