Analysis
Social care Changes elsewhere in the health and social care system may be needed too. Nuffield Trust chief executive Nigel Edwards says that social care services have a role in reducing hospital admissions by ensuring that hospitals can discharge patients quickly. ‘Much of the change needed relies on properly funded social care, but it has been cut to the bone.’ Royal College of Nursing Emergency Care Association chair Janet Youd welcomes publication of Five Year Forward View but is concerned about how its recommendations will affect staff. She says: ‘The principles set out could help EDs. Better integration in the community will make a big difference, if it is properly resourced, but moving care out of hospitals can stretch staff. In hospital, you benefit from economies of scale but, in the community, the money will not go as far. ‘We have been less good at looking after the mental and physical welfare of staff, and stress is a major problem,’ she adds. ‘The pay situation must be addressed too: staff have seen their pay cut in real terms in recent years and this cannot continue.’ Can the rise in ED pressures be reversed? Ms Youd hopes so, but is less optimistic than Professor Keogh. ‘We have to be sceptical about reductions in demand. The past tells us they are unlikely.’ See also opinion, page 13 Nick Triggle is a freelance journalist
Find out more The Five Year Forward View can be accessed at tinyurl.com/kcjenmc EMERGENCY NURSE
Cardiopulmonary resuscitation update iStock
It is hoped that more than two thirds of this gap is plugged by the document’s measures, but these require an extra £8 billion, or a 1.5% annual increase in funding for the next six years. Professor Keogh says: ‘The NHS needs to change. What we set out last year coupled with what is in the Five Year Forward View could make a real difference. This is about helping patients get the right care at the right time in the right place.’ The document provides case studies describing ways to reduce pressures in EDs. Three of these are set out below left.
Latest guidance states that practitioners discuss whether to resuscitate with patients or their families, writes Nick Lipley THE ROYAL College of Nursing (RCN), Resuscitation Council (UK) and British Medical Association (BMA) have issued a new edition of their guidance on when to attempt cardiopulmonary resuscitation (CPR). Decisions Relating to Cardiopulmonary Resuscitation has been updated to take into account developments in clinical practice and relevant legislation. The guidance emphasises the value of making anticipatory decisions about CPR as an integral part of good practice, and suggests that practitioners should draw up plans to explain and discuss such decisions with patients or their representatives at the earliest practicable opportunity. It also suggests that, to give CPR to a patient whose heart or breathing has stopped, regardless of his or her wishes, is to deny the patient an opportunity to refuse a treatment that may be of no benefit. When CPR has no realistic chance of success, the guidance states, practitioners should make decisions that are in the best interests of the patients concerned, and should not delay decisions because people are too unwell to have it explained to them or because their families or other representatives are unavailable. The importance of careful documentation and effective communication of decisions about CPR is also highlighted.
‘Situations that involve attempts to resuscitate patients are among the most difficult for all concerned,’ says RCN general secretary Peter Carter. ‘The new edition of the guidance makes clear that, with good, sensitive communication from staff, individuals can plan, make their wishes known and understand the consequences of decisions about resuscitation attempts. ‘Patients and their families benefit from the reassurance that the staff treating them have access to the best guidance, which is based on years of experience and the strongest evidence. In working together to produce and improve this guidance, doctors and nurses are helping ensure that these difficult situations are managed in a way that does not add to the distress and confusion of patients or their loved ones.’ Resuscitation Council (UK) chair David Pitcher adds: ‘When someone suffers sudden cardiac arrest, an immediate CPR attempt by members of the public and then by health professionals can be life saving, and we encourage people to do everything they can to help in that situation. ‘In contrast, trying to restart the heart of someone who is known to be dying from an advanced and irreversible condition provides no benefit and can do harm. Given the choice, many people do not want CPR in this situation, but it may be attempted if there is no discussion about it and no decision has been made.’ BMA medical ethics committee chair John Chisholm says: ‘Cardiorespiratory arrest is part of the final stage of dying. Although CPR is often portrayed on TV and film as a miraculous intervention that saves patients’ lives and reunites them with their loved ones, the truth is it carries the risk of internal fractures, ruptures and long-term brain damage. ‘Sadly, the survival rate is relatively low, and health professionals must be honest with their patients about the level of recovery that will be expected if CPR is attempted.’
Find out more The latest version of Decisions Relating to Cardiopulmonary Resuscitation is available at tinyurl.com/qg6v46y November 2014 | Volume 22 | Number 7
Downloaded from rcnpublishing.com by ${individualUser.displayName} on Feb 03, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCN Publishing Ltd. All rights reserved.
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Social care Changes elsewhere in the health and social care system may be needed too. Nuffield Trust chief executive Nigel Edwards says that social care services have a role in reducing hospital admissions by ensuring that hospitals can discharge patients quickly. ‘Much of the change needed relies on properly funded social care, but it has been cut to the bone.’ Royal College of Nursing Emergency Care Association chair Janet Youd welcomes publication of Five Year Forward View but is concerned about how its recommendations will affect staff. She says: ‘The principles set out could help EDs. Better integration in the community will make a big difference, if it is properly resourced, but moving care out of hospitals can stretch staff. In hospital, you benefit from economies of scale but, in the community, the money will not go as far. ‘We have been less good at looking after the mental and physical welfare of staff, and stress is a major problem,’ she adds. ‘The pay situation must be addressed too: staff have seen their pay cut in real terms in recent years and this cannot continue.’ Can the rise in ED pressures be reversed? Ms Youd hopes so, but is less optimistic than Professor Keogh. ‘We have to be sceptical about reductions in demand. The past tells us they are unlikely.’ See also opinion, page 13 Nick Triggle is a freelance journalist
Find out more The Five Year Forward View can be accessed at tinyurl.com/kcjenmc EMERGENCY NURSE
Cardiopulmonary resuscitation update iStock
It is hoped that more than two thirds of this gap is plugged by the document’s measures, but these require an extra £8 billion, or a 1.5% annual increase in funding for the next six years. Professor Keogh says: ‘The NHS needs to change. What we set out last year coupled with what is in the Five Year Forward View could make a real difference. This is about helping patients get the right care at the right time in the right place.’ The document provides case studies describing ways to reduce pressures in EDs. Three of these are set out below left.
Latest guidance states that practitioners discuss whether to resuscitate with patients or their families, writes Nick Lipley THE ROYAL College of Nursing (RCN), Resuscitation Council (UK) and British Medical Association (BMA) have issued a new edition of their guidance on when to attempt cardiopulmonary resuscitation (CPR). Decisions Relating to Cardiopulmonary Resuscitation has been updated to take into account developments in clinical practice and relevant legislation. The guidance emphasises the value of making anticipatory decisions about CPR as an integral part of good practice, and suggests that practitioners should draw up plans to explain and discuss such decisions with patients or their representatives at the earliest practicable opportunity. It also suggests that, to give CPR to a patient whose heart or breathing has stopped, regardless of his or her wishes, is to deny the patient an opportunity to refuse a treatment that may be of no benefit. When CPR has no realistic chance of success, the guidance states, practitioners should make decisions that are in the best interests of the patients concerned, and should not delay decisions because people are too unwell to have it explained to them or because their families or other representatives are unavailable. The importance of careful documentation and effective communication of decisions about CPR is also highlighted.
‘Situations that involve attempts to resuscitate patients are among the most difficult for all concerned,’ says RCN general secretary Peter Carter. ‘The new edition of the guidance makes clear that, with good, sensitive communication from staff, individuals can plan, make their wishes known and understand the consequences of decisions about resuscitation attempts. ‘Patients and their families benefit from the reassurance that the staff treating them have access to the best guidance, which is based on years of experience and the strongest evidence. In working together to produce and improve this guidance, doctors and nurses are helping ensure that these difficult situations are managed in a way that does not add to the distress and confusion of patients or their loved ones.’ Resuscitation Council (UK) chair David Pitcher adds: ‘When someone suffers sudden cardiac arrest, an immediate CPR attempt by members of the public and then by health professionals can be life saving, and we encourage people to do everything they can to help in that situation. ‘In contrast, trying to restart the heart of someone who is known to be dying from an advanced and irreversible condition provides no benefit and can do harm. Given the choice, many people do not want CPR in this situation, but it may be attempted if there is no discussion about it and no decision has been made.’ BMA medical ethics committee chair John Chisholm says: ‘Cardiorespiratory arrest is part of the final stage of dying. Although CPR is often portrayed on TV and film as a miraculous intervention that saves patients’ lives and reunites them with their loved ones, the truth is it carries the risk of internal fractures, ruptures and long-term brain damage. ‘Sadly, the survival rate is relatively low, and health professionals must be honest with their patients about the level of recovery that will be expected if CPR is attempted.’
Find out more The latest version of Decisions Relating to Cardiopulmonary Resuscitation is available at tinyurl.com/qg6v46y November 2014 | Volume 22 | Number 7
Downloaded from rcnpublishing.com by ${individualUser.displayName} on Feb 03, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCN Publishing Ltd. All rights reserved.
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