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ReSPECT

What is ReSPECT?

ReSPECT stands for:

Re-Recommended

S-Summary

P-Plan for

E-Emergency

C-Care and

T-Treatment

It is an alternative process for discussing, making and recording recommendations about future emergency care and treatment, including CPR.

UHNM will continue to have a separate Do Not Attempt Cardiopulmonary Resuscitation (DNARCPR) form until full ReSPECT implementation, when this decision will be reviewed. 

ReSPECT has been developed by multiple stakeholders, led by the Resuscitation Council, in order to achieve a process that will be adopted nationally.  It focuses on treatments to be considered as well as those that are not wanted or would not work.  It encourages people to plan ahead for their care and treatment in a future emergency where they may be unable to make decisions, however it is not a legally-binding document.

ReSPECT encourages conversations between people and clinicians, it also encourages planning in advance, better communication and documentation, shared decision making and, consequently, better care. 

ReSPECT is for everyone but is of particular relevance to people with specific healthcare needs, nearing the end of their lives, at risk of cardiac arrest or who want to record their preferences for any reason.

Trained staff guide appropriate patients through an extended conversation, often taking place over a number of days to allow families and carers to be involved. The process results in a completed ReSPECT form that details the person's wishes for their care, along with appropriate clinical recommendations.

The documentation is completed by medical and senior nursing staff involved in the discussions with patients/carers; however, the form must be signed by a consultant who is involved in the patient's care. 

It is in addition to the DNACPR decision, if one has been made, and is about much wider care preferences and treatment ceilings.  It is equally applicable to patients for whom resuscitation is appropriate. 

Patients who have a ReSPECT form completed will be discharged with the original document, which stays with them, and a digital copy will be saved on iPortal.

A ReSPECT alert on Medway has been approved and this is being rolled out as part of the implementation plan.  This will identify that a patient has a ReSPECT document should they re-present following discharge.

A ReSPECT documentation generic email address has also been created and a copy of each completed form is sent to this email address to facilitate communication with community colleagues, but will also support the audit process for each area. This will take place within six months of implementation.  The form can be reviewed based on individual circumstances or at the request of the person or family, or of the person's condition changes or moves from one care setting to another.

Prior to implementation of the initiative, all staff in the relevant clinical areas will receive appropriate training, provided by both medical and nursing colleagues at UHNM. Details are available on UHNM intranet and website and ReSPECT documentation has been added to the junior doctor induction programme. An information video for all Trust staff is also being produced.  

A wealth of information about ReSPECT and supporting resources for health professionals is also available at www.respectprocess.org.uk

Roll out is in 4 phases from October 2019 to January 2020.  Phase 1 commenced in October on all of the elderly care wards at Royal Stoke and at County.  Phase 2 will start at the beginning of December and will focus on the Emergency Departments and Acute Medical Units at both Royal Stoke and County, along with all medical wards at County. 

Phase 3, from mid-December, will cover Respiratory, Critical Care, Gastroenterology, Renal Medicine, General Medicine, Infectious Diseases, Cardiology and Haematology/Oncology. 

Phase 4 will be the last phase of the roll out and will cover all surgical wards/specialties, Neurology, Stroke will be completed by February 2020.

For more information on the ReSPECT implementation at UHNM, please contact Aideen Walsh, Deputy Medical Director; Diane Garratt, Transformation Programme Manager, or Julie O'Leary, Project Nurse.