NHS managers informed care homes to impose ‘do not resuscitate’ orders on all of their residents during the peak of the pandemic, according to a new report.
The Queen’s Nursing Institute (QNI) found that one in 10 care home staff surveyed were told to change resuscitation orders for patients without discussion with staff, family members or residents first.
What is a do not resuscitate order?
A do not resuscitate order (DNR) is a medical order written by a doctor that instructs health care providers not to perform cardio-pulmonary resuscitation (CPR) on a patient if their breathing stops, or their heart stops beating. The order is designed to prevent unnecessary suffering.
A DNR order is usually used in the following circumstances:
- when it will not restart the heart or breathing
- when there is no benefit to the patient
- when the benefits are outweighed by the burdens
The order does not affect any other medical treatments, such as pain medication.
The British Medical Association and the Royal College of Nursing state that DNR orders should only be issued following discussions with patients or their family.
Why were care homes told to introduce DNR orders?
The move to introduce the blanket DNR orders was intended to help keep hospital beds free, according to the study.
Professor Alison Leary MBE, who wrote the report, said that a survey of care home staff revealed that DNR orders were either blanket decisions for whole populations, or were imposed without discussion with the care home, family or the residents.
The report also found that at the height of the coronavirus outbreak, hospitals were refusing to admit residents from care homes.
One fifth of the 128 nurses and care home managers involved in the survey claimed to have received patients from hospitals who had tested positive for the virus.
Almost 50 per cent of staff said that residents sent to them from hospitals had arrived before they were tested.
Findings showed that more than half of all adult patients who were treated for coronavirus at a leading UK hospital were given DNR orders, or were barred from treatment in intensive care.
In total, less than one in five patients (18 per cent) were admitted to the intensive care unit for coronavirus.
At King’s College Hospital in London, a total of 61 per cent of coronavirus patients had treatment limitations placed on them during the peak of the pandemic, meaning they were denied access to potentially life-saving care.
A total of 16 care homes reported examples of poor end-of-life care, with four fifths of nursing staff reporting negative experiences of working in the pandemic.
More than half (56 per cent) said that their physical and mental health had suffered as a result.
Crystal Oldman, chief executive of the QNI, said the survey findings show the lack of support and access to health services were “symbolic” of how the NHS and government viewed the care home sector.
Ms Oldman expressed concern that care homes had struggled to access district nursing, GP and hospital services, and said it is vital the sector is involved in planning for a potential second wave of the virus, particularly with winter approaching.
She said: “We were really surprised to see this. These are universal health services. It is completely opposite to the protective ring around care homes that was being talked about at the time.
“These homes need to be equal partners, not abandoned and not have things done to them.
“If anything positive comes from what we have been through it’s that care homes cannot be viewed in that way again. It is everyone’s problem.”
This article was updated on 26 August to make it clear that one in 10 care home staff who took part in the QNI survey were told to change resuscitation orders for patients without discussion with staff, family members or residents first.