ReSPECT

The ReSPECT process can be for anyone, but it has clear relevance for people with complex health needs, people likely to be nearing the end of their lives, and people at risk of sudden deterioration or cardiac arrest. Some people may want to record their emergency care and treatment preferences for other reasons.

Trained staff guide appropriate patients through an extended conversation, often taking place over a number of days to allow families and carers to be involved. The process results in a completed ReSPECT form that details the person's wishes for their care, along with appropriate clinical recommendations.

The documentation is completed by medical and senior nursing staff involved in the discussions with patients/carers; however, the form must be signed by a consultant who is involved in the patient's care. 

The agreed realistic clinical recommendations that are recorded include a recommendation on whether or not CPR should be attempted if the person’s heart and breathing stop.

The ReSPECT process is being adopted in many communities throughout the UK. It is being used in settings including residential and nursing homes, GP practices, hospitals and hospices

Patients who have a ReSPECT form completed will be discharged with the original document, which stays with them, and a digital copy will be saved on iPortal.

There is an alert on the system that will identify that a patient has a ReSPECT document should they re-present following discharge.

The form can be reviewed based on individual circumstances or at the request of the person or family, or of the person's condition changes or moves from one care setting to another.

A wealth of information about ReSPECT and supporting resources for health professionals and the public is also available at www.respectprocess.org.uk

The implementation of ReSPECT at UHNM commenced in October 2019 in a phased approach.  Phase 1 commenced in October on all of the elderly care wards at Royal Stoke and at County.  Phase 2 at the beginning of December and focused on the Emergency Departments and Acute Medical Units at both Royal Stoke and County, along with all medical wards at County.  Phase 3, from mid-December, included Respiratory, Critical Care, Gastroenterology, Renal Medicine, General Medicine, Infectious Diseases, Cardiology and Haematology/Oncology.  Phase 4 of the roll out was completed by February 2020 and covered all of the surgical wards/specialties, Neurology and Stroke.

For more information regarding ReSPECT at UHNM, please contact Dr Zia Din, Deputy Medical Director or Diane Garratt, Transformation Programme Manager.

No. ReSPECT recommendations are to guide immediate decision-making by health and care professionals responding to the person in a crisis. However, they should be able to give valid reasons for overriding recommendations on a ReSPECT plan.

Anyone involved in the person’s care can initiate the process, when this seems likely to be helpful. It does not have to be a GP or hospital doctor and may, for example, be a nurse involved in the person’s care. Some people may ask for ReSPECT. If the professional who they ask cannot undertake a ReSPECT conversation, they should make sure they arrange for another clinician to do this. Technically, ReSPECT could be completed for any person at any time but, realistically, it will be used mostly for those whose health might deteriorate suddenly.

ReSPECT conversation(s) aim firstly to establish shared agreement about the person’s important health and care problems and needs, and the ways in which these could change in an emergency. The person’s preferences for their future care and treatment in any such emergency are the next key part of the discussion. This is followed by agreeing and recording recommendations that are realistic and could help the person achieve their goals of care.

1. The process is based on one or more conversations between a person and their clinicians. It is supported by a form, which acts as a summary of the discussion and is retained by the person (patient). Always sign and date the form.
2. The conversation(s) aims to establish a shared agreement about the person’s main clinical problems and needs, and the ways in which these could change to create an emergency. Record the outcome in Section 2 of the form.
3. The patient’s preferences for their future care and treatment in any such emergency are a key part of the discussion. Use Section 3 of the form to record these.
4. Take care to be specific when recording in Section 4:

a) care or treatments to be considered (e.g. treat supraventricular tachycardia with adenosine)

b) care or treatments that are not recommended (e.g. not for invasive ventilation).

5. Complete sections 5, 6 and 7 fully and carefully to confirm that the process has been followed and that the recommendations are lawful (e.g. compliant with capacity and human rights legislation). If a person lacks capacity to contribute to the ReSPECT process, this must take place with their legal proxy (e.g. Welfare Attorney) if they have one, or otherwise with a close family member.

6. Ensure that their ReSPECT conversations and form are documented in the person’s records and that an alert is registered showing they have a ReSPECT form.

7. Make sure section 8 records those involved in discussing this plan and essential emergency contacts.

8. Ensure all entries on the form are legible and unambiguous. Make sure that the wording used is appropriate for all community, ambulance and acute hospital staff to read, understand and be guided by.

9. The patient holds the form so they need to know:

a) what’s on it

b) what they should do with it.

10. Remember to review the entries on the form with them whenever a person’s condition changes or when they move from one care setting to another (e.g. Hospital to Nursing Home).