ReSPECT (Recommended Summary Plan for Emergency Care and Treatment)

ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) is a national patient held document, completed following an ACP (Advance Care Planning) conversation between a patient and a healthcare professional. We know that these conversations are not always easy to have and even more so, that patient’s do not want to have to re-tell their story or wishes to every healthcare professional they encounter.  The ReSPECT form will be rolled out in Gloucestershire across all organisations from 10th October 2019, current Treatment Escalation or DNAR forms (including the current version of the yellow sticker) will be phased out. Below you can find more information as well as training and educational materials for both staff who will be filling out ReSPECT forms and staff who will using but not completing them.

See an example of a ReSPECT form here.

ReSPECT training and educational resources are available here or by clicking the 'Clinician Education' icon above.

Why has Gloucestershire decided to adopt the ReSPECT process?

Currently across Gloucestershire:

  • Multiple documents for recording DNACPR decisions. ‘Yellow sticker’ most widely recognised but not the only document used leading to confusion/uncertainty for OOH/emergency practitioners such as paramedics over whether to accept documented decisions. Has led to attempts at CPR where this would not be recommended and inappropriate hospital transfers.
  • The focus on documenting DNACPR recommendations but more limited documentation of recommendations for other interventions. Different care settings have adopted ‘care priorities documents’ which may recommend ‘active ward care/transfer to acute hospital/transfer to Dept Critical Care’ but these are not relevant across all care settings for obvious reasons. Primary care teams may be uncertain of what secondary care can offer/would recommend as appropriate interventions and hence, refer patients into acute hospital without realising that they may have conditions refractory to treatments such as dialysis/non-invasive ventilation/ionotropes etc.  Not only can primary care be unaware but ‘front door’ in secondary care may also be unaware and mistakenly begin treatments which could lead to more distress/loss of dignity/prolonging dying/difficulties achieving an individual’s priority at end of life.
  • Lack of formal agreement across the system and consistent documentation also leads to repeated conversations with patients/those important to them which can cause distress in the context of advancing illness where the clinical situation will not alter and by having a discussion once, patients expect that the whole system will be aware of and abide by decisions/priorities/recommendations.

Introduction of ReSPECT across Gloucestershire will reduce variation in documentation enabling an improved consistent ‘language’ around care priorities and recommendations.

Improved documentation of appropriate interventions will lead to better co-ordinated care and fewer inappropriate transfers/trials of treatments where they are not wanted or are likely to cause more harm than provide benefit.

Contact Details

For questions or concerns regarding ReSPECT please contact your ReSPECT champion or:

emma.husbands@nhs.net - Palliative Care consultant
michelle.doidge@nhs.net - Lead GP End of Life Team GCCG
jodie.cook@nhs.net - Senior Project Officer - End of Life Care

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