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Patients' wishes for no treatment could be ignored at North Devon District Hospital

By North Devon Journal  |  Posted: January 16, 2014

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North Devon District Hospital has been ordered to make improvements after inspectors found there was a risk patients' wishes not be resuscitated may not be followed.

The Care Quality Commission (CQC) visited the hospital for a routine inspection last month.

The organisation, which mounts independent inspections of health trusts, issued a largely clean bill of health saying patients were well cared for in an adequately staffed environment at the Barnstaple based hospital.

However, the trust earned a black mark and action was demanded over whether patients were asked to agree to any examination, care, treatment or support before it occurred.

Inspectors concluded that this may lead to a risk of “inappropriate action” being taken over “do not resuscitate orders,” when a patient gives clear instructions that there should be no intervention in the event they cease breathing or their heart stops.

In their report, inspectors said: “The trust did not always act in accordance with legal requirements in relation to “do not resuscitate” orders.

“This meant there was a risk that inappropriate action could be taken which was not aligned with the wishes of patients or in their best interests.”

The inspectors said they examined records and spoke to many patients who praised the length doctors and nurses went to update them on their condition and explain what was happening.

Over, the team found gaps in provision for patients who were unable to make decisions for themselves.

A total of eight treatment plans were seen which did not follow the Resuscitation Council guidelines. A further two sets of notes indicted there was to be a discussion with a patient’s family, but were not updated to say whether it had taken place.

Inspectors said: “Overall we concluded where patients lacked capacity the trust did not evidence they always acted in accordance with legal requirements in relation to ‘do not attempt resuscitation’ orders.

“This meant inappropriate action could be taken that did not align with patient’s wishes or in their best interests.”

The CQC said North Devon Hospital must inform them of planned remedial action within three weeks and when compliance actions were complete.

“We will check to make sure that action has been taken to meet the standards and will report on our judgements,” said the inspectors.

Dr Alison Diamond, medical director at North Devon Hospital, said Treatment Escalation Plans (TEPs), which set out appropriate treatment choices for patients approaching the end of life were introduced across Devon around two years ago.

She said the issue raised by the CQC relates to the completion of a TEP form by a healthcare professional, for those patients who do not have capacity to make decisions for themselves.

Dr Alison Diamond, medical director, said: “TEPs are a very important form of communication.

“Although the CQC acknowledged in its inspection report that the documentation issues only had a minor impact and that we had already taken action to address them, we take the matter very seriously and are keen to look at the extent of the issues immediately.

“We are aware that the CQC has also raised the issue with other Trusts.

“We are meeting other Trusts shortly to review the use of TEPs and address the issues in closer detail, particularly in relation to the Mental Capacity Act and communication with patients and families."

“As a Trust we will be carrying out an audit to address the issues, and will also look at opportunities for staff training.”

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