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Assessing the quality of ReSPECT documentation using an accountability for reasonableness framework
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Eli, Karin, Hawkes, Claire, Fritz, Zoë , Griffin, James M., Huxley, Caroline J., Perkins, Gavin D., Wilkinson, Anna, Griffiths, Frances and Slowther, Anne-Marie (2021) Assessing the quality of ReSPECT documentation using an accountability for reasonableness framework. Resuscitation Plus, 7 . 100145. doi:10.1016/j.resplu.2021.100145
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RAP-Assessing-quality-ReSPECT-documentation-accountability-reasonableness-framework-2021.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution Non-commercial No Derivatives 4.0. Download (1444Kb) | Preview |
Official URL: https://doi.org/10.1016/j.resplu.2021.100145
Abstract
Background
The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form, which supports the ReSPECT process, is designed to prompt clinicians to discuss wider emergency treatment options with patients and to structure the documentation of decision-making for greater transparency.
Methods
Following an accountability for reasonableness framework (AFR), we analysed 141 completed ReSPECT forms (versions 1.0 and 2.0), collected from six National Health Service (NHS) hospitals in England during the early adoption of ReSPECT. Structured through an evaluation tool developed for this study, the analysis assessed the extent to which the records reflected consistency, transparency, and ethical justification of decision-making.
Results
Recommendations relating to CPR were consistently recorded on all forms and were contextualised within other treatment recommendations in most forms. The level of detail provided about treatment recommendations varied widely and reasons for treatment recommendations were rarely documented. Patient capacity, patient priorities and preferences, and the involvement of patients/relatives in ReSPECT conversations were recorded in some, but not all, forms. Clinicians almost never documented their weighing of potential burdens and benefits of treatments on the ReSPECT forms.
Conclusion
In most ReSPECT forms, CPR recommendations were captured alongside other treatment recommendations. However, ReSPECT form design and associated training should be modified to address inconsistencies in form completion. These modifications should emphasise the recording of patient values and preferences, assessment of patient capacity, and clinical reasoning processes, thereby putting patient/family involvement at the core of good clinical practice. Version 3.0 of ReSPECT responds to these issues.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine |
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| Divisions: | Faculty of Medicine > Warwick Medical School | ||||||||
| SWORD Depositor: | Library Publications Router | ||||||||
| Library of Congress Subject Headings (LCSH): | Cardiac resuscitation -- Evaluation, Emergency medical services, CPR (First aid), Medical emergencies, Cardiac resuscitation -- Standards -- England | ||||||||
| Journal or Publication Title: | Resuscitation Plus | ||||||||
| Publisher: | Elsevier BV | ||||||||
| ISSN: | 2666-5204 | ||||||||
| Official Date: | September 2021 | ||||||||
| Dates: |
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| Volume: | 7 | ||||||||
| Article Number: | 100145 | ||||||||
| DOI: | 10.1016/j.resplu.2021.100145 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access | ||||||||
| RIOXX Funder/Project Grant: |
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