East Lancs hospitals in 'do not resuscitate' bombshell

Burnley and Pendle Citizen: The medical profession believes resuscitation can cause unnecessary suffering The medical profession believes resuscitation can cause unnecessary suffering

THE Royal Blackburn and Burnley General hospitals have admitted that patients and families have not always been involved in important discussions about ‘Do Not Resuscitate’ orders.

As a result some patients have received CPR, which is used to restore breathing, when this was ‘possibly inappropriate’ say hospital chiefs.

The medical profession believes resuscitation can cause unnecessary suffering.

And one health champion also said he had received complaints from patients and families who said Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions had been made without their knowledge.

East Lancashire Hospitals NHS Trust (ELHT) has ordered extra training for staff after bosses found talks over resuscitation were ‘not always occurring with the relevant patients’.

The orders instruct doctors not to attempt CPR if a patient’s heart stops.

ELHT said it did not know the number of cases where resuscitation was not discussed, as it did not collect the data.

Professional guidance has stated the orders should only be used after discussions with the patient or their family, and this has now become a legal duty following a landmark judgement in the Court of Appeal last week Russ McLean, chairman of the Pennine Lancashire Patient Voices Group, said he has been contacted by a number of patients and families in the last year who complained about a lack of consultation over DNACPR decisions.

He added: “More and more patients have been telling me about this issue and I actually raised it with the trust last year.

“The court judgement may have only come last week, which makes it a legal duty, but there have still been clear ethical guidelines around this which should have been adhered to by everyone at the trust.

“I think any patient or family member would have expected to be involved in the decision as a matter of course. Doctors seem to have taken quite a cavalier attitude and I find it absolutely disgusting that discussions have not always been happening.”

However, he praised the trust’s chief nurse Christine Pearson for highlighting the issue in her monthly report to board members, saying that it suggested a more open and candid approach from bosses. Mrs Pearson wrote: “Discussions were not always occurring with relevant patients and if they were there was no clear evidence of the discussion.

“Documentation generally appeared inadequate with old forms being used and decisions not being clearly visible in patient’s notes and on discharge documentation.

“Work is now underway to roll out a Do Not Attempt Cardiopulmonary Resuscitation training package as part of the overarching End of Life Care training programme.”

Cardiopulmonary resuscitation, attempting to restore breathing or blood flow to critically-ill patients, is often a violent process with rib fractures and brain injury significant risks.

Up until the court ruling last week, healthcare workers have acted under professional guidance from the BMA and local trust policies, but there has been an apparent lack of clarity over just how far they have to go in consulting a patient or their families.

Dr Ian Stanley, medical director at ELHT, said a new policy was introduced in April last year to ensure that resuscitation discussions always took place with patients and their families.

He added: “We have had two main areas where DNACPR has been identified as an issue. One identified some concerns that there were decisions being made which were not fully discussed; this was fairly historical and was one of the reasons for us to re-emphasise our policy and ensure that all such decisions were discussed.

“As part of the mortality review process and case note reviews there was a view that some patients should have had a discussion about DNACPR as the chances of survival if they suffered cardiac arrest were very, very low and hence CPR would be inappropriate.

“I believe that the reasons the discussions are not taking place are related to adverse media coverage, confusion about the legal aspects and overall misconceptions that DNACPR means ‘do not treat’ - again our policy and training are very clear that this is not the case, but the public perception can be very different.”

He said a draft report by the Care Quality Commission, following a major inspection last month, had found that ‘appropriate discussions had taken place and were appropriately documented’.

He added: “This is a very emotive issue and one where real sensitivity is necessary. Firstly, ‘do not resuscitate’ absolutely does not mean ‘do not treat’. But for some patients with many co-existing diseases, or those who may be terminally ill, or very frail, there may be a significant chance that resuscitation following a cardiac arrest may be unsuccessful.

“In these circumstances, many patients are quite clear that they do not wish to be resuscitated, but this is often a very difficult concept for families and loved ones.

“We do our best to handle this in the most appropriate way but it is really important that doctors have these difficult discussions with patients, and that they are clearly documented so there is no cause for doubt. Families can then be clear that the wishes of their loved one are being respected.”

Dr David Wrigley, who represents Lancashire doctors in the British Medical Association, said: "Decisions regarding cardiopulmonary resuscitation can be complex and incredibly distressing for patients and people emotionally close to them. Therefore we welcome the judgment's clarification of the law in this complex area of medicine and are committed to updating our guidance as policy and legislation develops."

Paul Foley, who represents East Lancashire nurses in the Unison union, said: “In their day-to-day work NHS staff treat patients and their families with great dignity and respect, sometimes in the most difficult and distressing circumstances. We welcome the Court of Appeal’s ruling as we believe that patients should always be involved in decisions about all aspects of their clinical care.”

Comments (16)

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10:07am Thu 26 Jun 14

vicn1956 says...

Are things improving?
It seems that there's a bad news story every day and a lot of people are being paid very well for-what?
Meanwhile the people at the coal face...............
Are things improving? It seems that there's a bad news story every day and a lot of people are being paid very well for-what? Meanwhile the people at the coal face............... vicn1956
  • Score: 13

10:32am Thu 26 Jun 14

kapalski says...

I think Mr Stanley should chose his words carefully!!

Who do these people think they are to impose such orders onto medical records with no discussion with any family members, especially if the patient is lacking the capacity to make such a decision!!

Whilst I am in agreement that in SOME cases CPR may not be successful and in some only prolong the pain they suffer. I do not believe this trust, or any other have the right to decide this without patient/family discussions.

How many people have they done this to? And had this type of case not gone to the High Courts, would they have been so forthcoming with this information? NO!
I think Mr Stanley should chose his words carefully!! Who do these people think they are to impose such orders onto medical records with no discussion with any family members, especially if the patient is lacking the capacity to make such a decision!! Whilst I am in agreement that in SOME cases CPR may not be successful and in some only prolong the pain they suffer. I do not believe this trust, or any other have the right to decide this without patient/family discussions. How many people have they done this to? And had this type of case not gone to the High Courts, would they have been so forthcoming with this information? NO! kapalski
  • Score: 22

10:55am Thu 26 Jun 14

alan7554 says...

On July 18th 2008 at 5-00 .m I received a phone call from the ward sisterat BRI informing me my mum was dying I rushed up to the side room that my mum had been in since her operation and there were wires and all things wired up to her, granted she was very grey and she was struggling to breathe,so i knew that she was in a bad way,whilst i was standing near her,a nurse said come on Jean we want to take some blood,this I thought was very strange as she was dying,I was ushered out of the room and told to wait in a side room for 5- 10 minutes whilst mum was sorted out,in the nurses own words. Can anyone imagine my shock and horrorwhen i was told that iculd go back in and on entering the room found my mum DEAD and all the machines gone out off the room. My vow was my mum brought me into this world and I wanted to be with her when she departed this world.Not only was i denied that honour I was also asking myself why stand over her with a Hypodermic needle in one hand telling me that they want a blood sample.I can't prove it but in my heart and mind my mum was helped into the next world.I did not have a say in staying with her to the end and even now 6years later it still is on my mind.
On July 18th 2008 at 5-00 .m I received a phone call from the ward sisterat BRI informing me my mum was dying I rushed up to the side room that my mum had been in since her operation and there were wires and all things wired up to her, granted she was very grey and she was struggling to breathe,so i knew that she was in a bad way,whilst i was standing near her,a nurse said come on Jean we want to take some blood,this I thought was very strange as she was dying,I was ushered out of the room and told to wait in a side room for 5- 10 minutes whilst mum was sorted out,in the nurses own words. Can anyone imagine my shock and horrorwhen i was told that iculd go back in and on entering the room found my mum DEAD and all the machines gone out off the room. My vow was my mum brought me into this world and I wanted to be with her when she departed this world.Not only was i denied that honour I was also asking myself why stand over her with a Hypodermic needle in one hand telling me that they want a blood sample.I can't prove it but in my heart and mind my mum was helped into the next world.I did not have a say in staying with her to the end and even now 6years later it still is on my mind. alan7554
  • Score: 33

11:09am Thu 26 Jun 14

kateash says...

alan7554 wrote:
On July 18th 2008 at 5-00 .m I received a phone call from the ward sisterat BRI informing me my mum was dying I rushed up to the side room that my mum had been in since her operation and there were wires and all things wired up to her, granted she was very grey and she was struggling to breathe,so i knew that she was in a bad way,whilst i was standing near her,a nurse said come on Jean we want to take some blood,this I thought was very strange as she was dying,I was ushered out of the room and told to wait in a side room for 5- 10 minutes whilst mum was sorted out,in the nurses own words. Can anyone imagine my shock and horrorwhen i was told that iculd go back in and on entering the room found my mum DEAD and all the machines gone out off the room. My vow was my mum brought me into this world and I wanted to be with her when she departed this world.Not only was i denied that honour I was also asking myself why stand over her with a Hypodermic needle in one hand telling me that they want a blood sample.I can't prove it but in my heart and mind my mum was helped into the next world.I did not have a say in staying with her to the end and even now 6years later it still is on my mind.
Ask to see her notes..and get some advice from a solicitor . Nothing should be done to a patient without their knowledge or that of the relatives !
[quote][p][bold]alan7554[/bold] wrote: On July 18th 2008 at 5-00 .m I received a phone call from the ward sisterat BRI informing me my mum was dying I rushed up to the side room that my mum had been in since her operation and there were wires and all things wired up to her, granted she was very grey and she was struggling to breathe,so i knew that she was in a bad way,whilst i was standing near her,a nurse said come on Jean we want to take some blood,this I thought was very strange as she was dying,I was ushered out of the room and told to wait in a side room for 5- 10 minutes whilst mum was sorted out,in the nurses own words. Can anyone imagine my shock and horrorwhen i was told that iculd go back in and on entering the room found my mum DEAD and all the machines gone out off the room. My vow was my mum brought me into this world and I wanted to be with her when she departed this world.Not only was i denied that honour I was also asking myself why stand over her with a Hypodermic needle in one hand telling me that they want a blood sample.I can't prove it but in my heart and mind my mum was helped into the next world.I did not have a say in staying with her to the end and even now 6years later it still is on my mind.[/p][/quote]Ask to see her notes..and get some advice from a solicitor . Nothing should be done to a patient without their knowledge or that of the relatives ! kateash
  • Score: 24

11:37am Thu 26 Jun 14

woolywords says...

Buried in this, is the bit that I've never understood; where a patient carries a donor car, yet next of kin have to give informed consent for this harvest to take place. Surely, as an adult, I have the right to choose what becomes of my body after my death.
If I can opt for burning in an open pit, buried either vertically or horizontally, facing whatever direction, cremated, buried at sea or in my case, donated to medical science then someone else comes along, makes another contrary decision where my choice, is set aside; just seems to be so wrong.
If it just so happens on the day that they speak to the one member of my family who disagrees with my choice, does that mean that my wishes are ignored?
Does this mean that my signature, on a form or on a living will, is worthless, when it comes to what 'Doctor knows best'?
This whole sad state of affairs wants sorting out, with clear and patent rules, that are adhered to by all and don't require testing in a court, where the only beneficiaries of my little estate would be, the lawyers...
Buried in this, is the bit that I've never understood; where a patient carries a donor car, yet next of kin have to give informed consent for this harvest to take place. Surely, as an adult, I have the right to choose what becomes of my body after my death. If I can opt for burning in an open pit, buried either vertically or horizontally, facing whatever direction, cremated, buried at sea or in my case, donated to medical science then someone else comes along, makes another contrary decision where my choice, is set aside; just seems to be so wrong. If it just so happens on the day that they speak to the one member of my family who disagrees with my choice, does that mean that my wishes are ignored? Does this mean that my signature, on a form or on a living will, is worthless, when it comes to what 'Doctor knows best'? This whole sad state of affairs wants sorting out, with clear and patent rules, that are adhered to by all and don't require testing in a court, where the only beneficiaries of my little estate would be, the lawyers... woolywords
  • Score: 14

11:47am Thu 26 Jun 14

woolywords says...

And by the way, can we have some clarification on just who is my next of kin, as there is no legal definition of that, within the UK, at all!
It's not my dear Mum (still alive and kicking), my eldest nor younger brothers, nor is it either of my daughters.
I can, if I were minded to, nominate my drinking buddy, as long as he consents to it; how mad is that?
It just goes to show how this sorry state of affairs has never been properly addressed as it should have been, years ago.
And by the way, can we have some clarification on just who is my next of kin, as there is no legal definition of that, within the UK, at all! It's not my dear Mum (still alive and kicking), my eldest nor younger brothers, nor is it either of my daughters. I can, if I were minded to, nominate my drinking buddy, as long as he consents to it; how mad is that? It just goes to show how this sorry state of affairs has never been properly addressed as it should have been, years ago. woolywords
  • Score: 8

11:56am Thu 26 Jun 14

HelmshoreMan2010 says...

vicn1956 wrote:
Are things improving?
It seems that there's a bad news story every day and a lot of people are being paid very well for-what?
Meanwhile the people at the coal face...............
There is quite a lot of bad news stories but if we heard a story about every life saved people might not have such a negative view of the NHS.

Granted it's far from perfect but it's good enough for half of the world to want to come to the UK to use it!
[quote][p][bold]vicn1956[/bold] wrote: Are things improving? It seems that there's a bad news story every day and a lot of people are being paid very well for-what? Meanwhile the people at the coal face...............[/p][/quote]There is quite a lot of bad news stories but if we heard a story about every life saved people might not have such a negative view of the NHS. Granted it's far from perfect but it's good enough for half of the world to want to come to the UK to use it! HelmshoreMan2010
  • Score: 17

1:38pm Thu 26 Jun 14

vicn1956 says...

Everything's fine then Mr.Magoo!
Everything's fine then Mr.Magoo! vicn1956
  • Score: -1

3:55pm Thu 26 Jun 14

the beaver says...

right then get super claret put a gip mask on with no breathing holes and dump him at the hospital good riddens!!
right then get super claret put a gip mask on with no breathing holes and dump him at the hospital good riddens!! the beaver
  • Score: 0

5:42pm Thu 26 Jun 14

Robbie says...

Personally, I think it should be down to the hospital rather than the family to decide.

some families judgement will be clouded by emotion, a doctors is not, a doctors judgment is made on the medical merits of each case and what is in the best interests of the ill/injured party.
Personally, I think it should be down to the hospital rather than the family to decide. some families judgement will be clouded by emotion, a doctors is not, a doctors judgment is made on the medical merits of each case and what is in the best interests of the ill/injured party. Robbie
  • Score: -8

5:45pm Thu 26 Jun 14

phil kernot says...

alan7554 wrote:
On July 18th 2008 at 5-00 .m I received a phone call from the ward sisterat BRI informing me my mum was dying I rushed up to the side room that my mum had been in since her operation and there were wires and all things wired up to her, granted she was very grey and she was struggling to breathe,so i knew that she was in a bad way,whilst i was standing near her,a nurse said come on Jean we want to take some blood,this I thought was very strange as she was dying,I was ushered out of the room and told to wait in a side room for 5- 10 minutes whilst mum was sorted out,in the nurses own words. Can anyone imagine my shock and horrorwhen i was told that iculd go back in and on entering the room found my mum DEAD and all the machines gone out off the room. My vow was my mum brought me into this world and I wanted to be with her when she departed this world.Not only was i denied that honour I was also asking myself why stand over her with a Hypodermic needle in one hand telling me that they want a blood sample.I can't prove it but in my heart and mind my mum was helped into the next world.I did not have a say in staying with her to the end and even now 6years later it still is on my mind.
The same thing happened to my mum in 2012 at Blackpool vic ,,, got a phone call in the morning things are fine ,,, then I got one at 4pm saying you have to come over now its urgent ,, got there was asked to sign DNR form I said no , do your best to help mum ,, got phone call later that might mum had passed away ,, but I feel in my stomach , things were happening behind my back that shouldn't have been happening
[quote][p][bold]alan7554[/bold] wrote: On July 18th 2008 at 5-00 .m I received a phone call from the ward sisterat BRI informing me my mum was dying I rushed up to the side room that my mum had been in since her operation and there were wires and all things wired up to her, granted she was very grey and she was struggling to breathe,so i knew that she was in a bad way,whilst i was standing near her,a nurse said come on Jean we want to take some blood,this I thought was very strange as she was dying,I was ushered out of the room and told to wait in a side room for 5- 10 minutes whilst mum was sorted out,in the nurses own words. Can anyone imagine my shock and horrorwhen i was told that iculd go back in and on entering the room found my mum DEAD and all the machines gone out off the room. My vow was my mum brought me into this world and I wanted to be with her when she departed this world.Not only was i denied that honour I was also asking myself why stand over her with a Hypodermic needle in one hand telling me that they want a blood sample.I can't prove it but in my heart and mind my mum was helped into the next world.I did not have a say in staying with her to the end and even now 6years later it still is on my mind.[/p][/quote]The same thing happened to my mum in 2012 at Blackpool vic ,,, got a phone call in the morning things are fine ,,, then I got one at 4pm saying you have to come over now its urgent ,, got there was asked to sign DNR form I said no , do your best to help mum ,, got phone call later that might mum had passed away ,, but I feel in my stomach , things were happening behind my back that shouldn't have been happening phil kernot
  • Score: 10

6:02pm Thu 26 Jun 14

davemcb says...

HelmshoreMan2010 wrote:
vicn1956 wrote:
Are things improving?
It seems that there's a bad news story every day and a lot of people are being paid very well for-what?
Meanwhile the people at the coal face...............
There is quite a lot of bad news stories but if we heard a story about every life saved people might not have such a negative view of the NHS.

Granted it's far from perfect but it's good enough for half of the world to want to come to the UK to use it!
Only the third world. Outcomes in almost every other developed country are better.
[quote][p][bold]HelmshoreMan2010[/bold] wrote: [quote][p][bold]vicn1956[/bold] wrote: Are things improving? It seems that there's a bad news story every day and a lot of people are being paid very well for-what? Meanwhile the people at the coal face...............[/p][/quote]There is quite a lot of bad news stories but if we heard a story about every life saved people might not have such a negative view of the NHS. Granted it's far from perfect but it's good enough for half of the world to want to come to the UK to use it![/p][/quote]Only the third world. Outcomes in almost every other developed country are better. davemcb
  • Score: 4

6:07pm Thu 26 Jun 14

useyourhead says...

they discussed a dnr with us and my mum, she agreed to it, but there was very little tact or thought and some of the words and phrases chosen by the doctor were very brutal, i understand they have to make sure no one is under any illusion as to what it means but at the same time please remember that we are people, with feelings and fears.
they discussed a dnr with us and my mum, she agreed to it, but there was very little tact or thought and some of the words and phrases chosen by the doctor were very brutal, i understand they have to make sure no one is under any illusion as to what it means but at the same time please remember that we are people, with feelings and fears. useyourhead
  • Score: 6

7:47pm Thu 26 Jun 14

peely says...

Can the LT not find anything to write about other than what,s happening at Royal Blackburn . Why don,t they interview some of the patients who are more than happy with their care and have nothing but praise for the doctors and nurses who work there ?
Can the LT not find anything to write about other than what,s happening at Royal Blackburn . Why don,t they interview some of the patients who are more than happy with their care and have nothing but praise for the doctors and nurses who work there ? peely
  • Score: 1

9:24pm Thu 26 Jun 14

Chris P Bacon says...

Robbie wrote:
Personally, I think it should be down to the hospital rather than the family to decide.

some families judgement will be clouded by emotion, a doctors is not, a doctors judgment is made on the medical merits of each case and what is in the best interests of the ill/injured party.
...is one way of looking at it but another way.... A relative is far more valuable to the family than to a hospital where they are sometimes considered as 'bothersome bed-blockers'; after all, there's no end of customers for the service out there. One patient in a hospital bed is preventing ten others from occupying it.

The only way to cope with this is to be as educated as you can be as to how the current system works and obtain what you and your parents' and your grandparents' endless contributions have paid for.

You get what you settle for. Settle for nothing less than the FIRST best.
[quote][p][bold]Robbie[/bold] wrote: Personally, I think it should be down to the hospital rather than the family to decide. some families judgement will be clouded by emotion, a doctors is not, a doctors judgment is made on the medical merits of each case and what is in the best interests of the ill/injured party.[/p][/quote]...is one way of looking at it but another way.... A relative is far more valuable to the family than to a hospital where they are sometimes considered as 'bothersome bed-blockers'; after all, there's no end of customers for the service out there. One patient in a hospital bed is preventing ten others from occupying it. The only way to cope with this is to be as educated as you can be as to how the current system works and obtain what you and your parents' and your grandparents' endless contributions have paid for. You get what you settle for. Settle for nothing less than the FIRST best. Chris P Bacon
  • Score: 5

10:55am Fri 27 Jun 14

bacupbabe says...

I have a good news story about the NHS and resuscitation. My mother was 86 and went for an operation to repair her hip after a fall. She did not come round naturally from the operation and we were sent for. When arrived at the hospital she was on a breathing machine and it was explained that she was being transferred to another hospital where there was an intensive care bed. Despite my mother having several other medical problems at no time was it suggested that DNR was appropriate. We were fully informed that the outcome may not be good but that the staff felt she should be given a chance after 3 days she was taken off the life support machine and she breathed on her own. Thanks to the wonderful care and understanding of the NHS staff we went on to have 4 more wonderful years with my Mum and she died peacefully in her own bed at home aged 90.
I have a good news story about the NHS and resuscitation. My mother was 86 and went for an operation to repair her hip after a fall. She did not come round naturally from the operation and we were sent for. When arrived at the hospital she was on a breathing machine and it was explained that she was being transferred to another hospital where there was an intensive care bed. Despite my mother having several other medical problems at no time was it suggested that DNR was appropriate. We were fully informed that the outcome may not be good but that the staff felt she should be given a chance after 3 days she was taken off the life support machine and she breathed on her own. Thanks to the wonderful care and understanding of the NHS staff we went on to have 4 more wonderful years with my Mum and she died peacefully in her own bed at home aged 90. bacupbabe
  • Score: 1

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