Hospitals are wrongly trying to resuscitate some of the most infirm, elderly patients when they are dying, according to a health watchdog. The National Confidential Enquiry into Patient Outcome and Death, NCEPOD, reviewed the care given to 585 acutely-ill patients who ended up having a cardiac arrest.
It concluded that cardiopulmonary resuscitation, CPR, had wrongly become the “default setting” and said a third of the cardiac arrests could have been prevented.
The findings are revealed in a the NCEPOD’s latest report Time to Intervene? Report author and NCEPOD lead clinical co-ordinator Dr George Findlay said: “Senior doctors must be involved in the care planning process for acutely ill patients at an earlier stage, and support junior doctors to recognise the warning signs when a patient is deteriorating. The lack of senior input fails patients by both missing the opportunity to halt deterioration and also by failing to question if CPR will actually improve outcome.”
In one case, hospital nursing staff expressed concern about a very elderly, acutely ill patient with severe dementia. The patient had no CPR plan and was dying. When the patient went into cardiac arrest, CPR was performed for 10 minutes until a senior doctor halted the procedure. All the patient’s reviews had been carried out by junior doctors. NCEPOD Advisors reported: “This was an undignified end of life that need not have happened.”
NCEPOD chairman Bertie Leigh said that he hoped the report would prompt a rethink on the limits of what is possible, and act as a wake up call to the NHS: “In nearly half of all the cases we reviewed there was a failure to formulate an appropriate care plan on admission, and a failure, often over several days, to find out what the patient’s wishes were – and to carry them out.”
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