ReSPECT and COVID-19
Having conversations around ReSPECT regarding COVID19 is clearly very difficult when an aim could be to get a cohort of vulnerable patients with significant multi-morbidities to agree to no hospital or maybe hospice admission even though non invasive ventilation (NIV) and oxygen might save them
Following these conversations what to write on ReSPECT forms can be difficult. To help you see below some examples of wording (this is a previous version of the form – see link further down to version 3)
Electronic ReSPECT Forms
Increasing the amount of EOLC planning should be considered wherever possible, so please consider undertaking a ReSPECT discussion during a remote consultation.
Complete remotely the new electronic form with an electronic signature (this is simply a typed name) and GMC number.
In order to be IG compliant the document needs to be saved as a PDF in the patient notes.
Updated Version 3 Electronic Form
An updated version of the form has been released in August 2020
|What you will see in version 3||Reason for the change|
|Inclusion of a statement about the process being based around a conversation.
States that the recorded recommendations are not legally binding.
|Puts the focus on the conversation and the individual’s perspective.
Makes clearer to the user the recorded recommendations are not legally binding.
|Changes to the wording in section 2 to encourage clinicians to record information about the person’s personal circumstances. Section is now called ‘Shared understanding of my health and current condition’.
The question about whether the person has a legal proxy has been moved from the back of the form to the front in section 2.
|Puts more emphasis on shared understanding of the situation between the professional and patient.
Enables recording earlier in the process of whether the person has a legal proxy.
|The scale in section 3 ‘What matters to me in decisions about my treatment and care in an emergency’ has been converted to a visual aid.||In the previous version people were given an option to mark on the scale where they viewed their wishes between prioritising sustaining life and prioritising comfort. This caused some confusion to people and often they did not complete this section.|
|In section 3 ‘What matters to me in decisions about my treatment and care in an emergency’, the patient is now asked what they most value and what they fear most/wish to avoid.||This is important information that supports better understanding of the patient and their needs, and clearer recording of what matters to them.|
|In section 4 ‘clinical recommendations for emergency care and treatment’, the language has been made more personable.||Feedback from patients and the public highlighted the need for more personable language.|
|In section 4 ‘clinical recommendations for emergency care and treatment’ a third option has been made available – the ability to record a clinical recommendation to balance extending life with comfort and valued outcomes.||This additional option reflects the fact that for some patients, based on their values, a balanced approach will be the recommendation. Feedback was that the previous form gave the impression that the clinician needed to make a binary decision which often did not reflect the patient’s realistic preferences.|
|In section 5 ‘Capacity for involvement in making this plan’ the wording has been changed to ensure that when decisions are made without involving the patient, the reasons for this are clearly recorded. There is also an important reminder that if the person lacks capacity a ReSPECT conversation must take place with the legal proxy and/or family.
|Provides clearer wording to encourage clinicians to record clearly in what way the person lacks capacity and the reason why the patient wasn’t involved in the conversation.
The reminder about involving the legal proxy and/or family will help ensure that the legal proxy and/or family is always involved in making best-interest decisions when the patient lacks mental capacity for those decisions.
|The option for patient/legal proxy or family member to sign the document to allow them to show they have been actively involved in the discussion and recommendations about their/their family member’s care and treatment.
|We had received feedback from some patients, families and clinicians that they would value the ability for a person/their legal proxy or family member to sign the document to confirm their involvement in the conversation and recorded recommendations.|
Click on image below for link to electronic ReSPECT form (version 3)
If required the pdf version can then be printed at the practice (or in the future in one of the resilience hubs) to then send on to a patient or Care Home. Alternatively the completed electronic PDF form could be emailed to a Care Home using a secure NHS.net account.
Please refer to flow diagram explaining the process.