Doctors may have made blanket decisions about “do not resuscitate orders” without the input of patients or their families during the first wave of the pandemic, the care watchdog has warned.
The Care Quality Commission (CQC) said the number of complaints it had received about do not attempt cardiopulmonary resuscitation (DNACR) orders jumped to 40 between March and September.
There were just nine similar complaints in the previous six months.
One carer said an on-call doctor had informed care home staff that if a resident were to catch Covid-19, a DNACPR order would automatically be put in place.
Another witness said some care homes and learning learning disability services had been told by GPs to place blanket orders on everyone in their care.
Early results of the CQC’s investigation found DNACPRs may have been used inappropriately when care services were under extreme pressure following misunderstanding of the guidance on their use.
Only 15% to 20% of those who undergo the highly invasive resuscitation procedure in hospital survive, with survival rates dropping to between 5% and 10% outside of a hospital setting.
Although it can cause punctured lungs, fractured ribs and severe bruising, failing to fully appraise a patient or their loved ones of their options is a breach of their human rights, the CQC warned.
CQC guidance states decisions on DNACPRs must never be dictated by blanket policies, must be free from discrimination, and not made on a clinician’s “subjective view of a person’s quality of life”.
Despite reminding care providers of their obligations, the CQC said it had received evidence from staff and patients’ families that DNACPR orders had been applied without consultation.
Others said they said it was unclear how or whom to escalate concerns to.
One senior member of staff at a care home said staff had successfully challenged every inappropriate DNACPR order they were aware of, but this had been difficult and the felt clinicians had ignored their concerns.
Some families of patients said they were not made aware such an order was in place until their relative was quite unwell.
Others said they had been told their loved one had agreed to a DNACPR order, but they had concerns over their understanding due to factors such as a lack of English or deafness.
The CQC also found examples of routine care not being provided in homes, such as an ambulance or doctor not being called, due to the existence of the do not resuscitate order.