Blanket order on all care homes to place Do Not Resuscitate orders on all residents

Well if you're going to base your posts on newspaper headlines, your just going to repeat sensational and inaccurate information.

Did you not think to read any further. Or maybe even look at the report before you spread alarmist, fake news?

Now why would you do that? ?

EllanVannin

This would first and foremost have to be sanctioned by the relatives and not staff/doctors or anyone else. A discussion between relatives and a doctor would have to take place and a full explanation given regarding a person's state of health.

Nobody can enforce back-door euthanasia !

It is not euthanasia, it means that if a person stops breathing and their heart stops beating then chest compressions are not started. It does not apply when it is a reversible cause such as choking or an anaphylactic reaction is the cause. It does not, and never has meant not treating someone for an infection, heart attack or stroke but to name but a few conditions. It is a medical decision and although it is good practice to discuss it with relatives it is ultimately the decision of the medical professional in charge of the patients care.
Out of hospital cardiac arrest treatment has a very low success rate and even lower survival to hospital discharge rate.

Even the headline says "asked" not "told"
Anyone can read the Times article for themselves. Ignore the headline and read the article and the quotes from people on the ground and connected with the situation. Use yout own common sense to see what has actually been said by real people, and to understand what "do not resuscitate" means (not "do not treat their illness" but "do not attempt to bring them back to life if they have no breathing or heartbeat" ) and then decide whether to be outraged or not.
Here is the link again www.telegraph.co.uk/news/2020/08/23/care-homes-asked-place-blanket-do-not-resuscitate-orders-residents/

Don’t know about anyone else, but I’d never have wanted CPR for my elderly mother, which is why there was a ‘no thanks’ on her records - she had dementia.

An elderly neighbour was resuscitated after his 2nd heart attack. He told me later that the after-effects were so painful, he wished they’d just let him die.
He did in fact die a few months later anyway.

I know some relatives do want absolutely everything done to keep a very elderly person going, no matter how poor the state they’re in, but IMO it can verge on cruelty. I’ve known someone be utterly furious at the suggestion* that it might be kinder to let Nature take its course.

She actually said, ’How dare you? I’m not ready to let her go!’ In other words, she was thinking more of herself than of her loved one.
*not from me,I hasten to add!

westendgirl

The actual headline in the Times is " Care homes 'ordered not to resuscitate ' as pandemic took hold.

"Care homes were asked to introduce blanket "do not resuscitate " orders for all residents at the height of the coronavirus pandemic , it has been claimed"
As you can see I was quoting from the Times . It is there for you all to read , which I stated in the second post.
My original post was asking if you thought there should be an inquiry.

Hate to be picky but your title said ALL

Which it wasn't

But that aside there are many old people in nursing homes who have DNRs in place.

Virus or no virus.

Do not resuscitate has been on residents notes since I first worked in care 30 odd years ago.

With or without the virus, people's bodies get to the point where it does more harm than good. .(and of course, it rarely works, anyway)

Here is the article

And the rest

I find this shocking and think there should definitely be an enquiry. Surely the concerns should be examined in case of another spike so that we can be sure the most vulnerable in society are protected.

I can’t believe so many posters seem to be so complacent about this and more concerned with rubbishing the OP. Even if you don’t agree with what someone posts there’s no need to be so bloody rude about it.

Not complacent, simply factual.

I font think it's rude to point out that someone is posting false information.

I do think it's shocking that somebody deliberately sets out to cause alarm and anxiety by posting what is not true.

Thank you night owl. As I have already said I was concerned when I read it and did wonder if posters thought there should be an inquiry.
Lucca thanks for putting the article up, and Growstuff that's the article I referred to .

I think everyone agrees with the spirit of the post and hopes that an enquiry will make it clear whether care homes were instructed to put DNA on everyone's notes, regardless of their or their family's wishes, or asked to make sure that they had discussed resuscitation choices with their patients. With the prospect (in April) of a pandemic which could see older patients very ill, reviewing their notes to check on this is a reasonable reminder.

What posters have said is that the TITLE is a misquote of the headline that the OP thought they were quoting. The word ALL wasn't in it.

Here are a couple of things to consider.

1. DNR does not mean "do not treat", nor is it backdoor euthanasia. People can still be treated for medical issues if they have a DNR. All it means is that they won't be given CPR and a code will not be called.

2. When we consider that CPR is treatment, it does not have to be offered to patients who are unlikely to benefit from it. CPR is effective in older people <1% of the time. It's more likely to be an extremely traumatic experience involving rib fractures, for example. Would you give someone chemotherapy if they didn't have cancer?

The Times article has some selective journalism too.

"One on ten care homes..." only mentioning later in the article that this was one in 10 of 128 homes selected for the survey, not chosen at random.

Poor research. Poor journalism.

Many thanks to all the posters pointing out that despite a DNAR decision, older people still receive treatment for health conditions and treatment to make them as comfortable as possible, such as oxygen and pain relief. Also for pointing out that resuscitation is mostly unsuccessful, especially with older people. On the many resuscitation update courses I attended as an older people's nurse, this was always emphasised by the trainers who were experienced health care professionals specialising in resuscitation and some had responded to hundreds of incidents. It's often not like the tv dramas and soaps. On our ward, we always dreaded subjecting our dying patients to this if no DNAR decision was in place. What a terrible way to leave this world, being given chest compressions and maybe fractured ribs etc. Although we were all ready to perform our duty and resuscitate according to the decisions made, fortunately it didn't happen very often because medics are usually very good at treating patients and identifying and treating problems before the patient has a cardiac arrest. I have never known a DNAR placed on a patient without adequate and sensitive discussion and giving the family time to discuss between themselves. Most health professionals that I knew took pride in dealing with patients and families with sensitivity and respect. It is a shame to think that maybe it is different in some places currently. I can remember only 2 older patients who were resuscitated on our ward. Both were transferred to intensive care, both died within a few days and experienced further distress instead of a more peaceful end.

I accept that the word all was in the wrong place and apologise for that.
I was concerned when I read the piece and wondered what other posters would think about an inquiry .
Illte , you cannot possibly know what was in my head when I wrote the post and to hint that I'd
set out to cause alarm and anxiety etc is quite derogatory.

A lesson in 1) checking your facts and/or sources and b) choosing your words carefully I think!
I, too, did a double take when I saw this thread, but having read an article on the subject was not as alarmed as I might have been.
It is not uncommon on social media and reactions of outrage can escalate like the proverbial Chinese Whispers.

No I can't know what was in your head,. I can only form my judgement on the way you ignored the actual report and took the decision to post innacurate information that did alarm at least one other member. And perhaps others.

Only you know your reasons.

Missadventure and Witzend - thank you. DNR is not euthanasia, in any way shape and form- but it is allowing someone who has a heartattack or whose body shuts down due to very ald age and multiple healthproblems- to go naturally and quietly.

My issue with this in this instance- is that I do not trust the Government to give advice which is in the best interest of patients for the right reasons.

I still think it’s extremely rude to accuse someone of lying just because they post something slightly inaccurate. And while there might be an argument for saying older people would be best served by having DNAR orders in place (though I’m not convinced of it as a general policy) I find it deeply disturbing that this may have been suggested in care homes for those with learning disabilities. As I said, this affects the most vulnerable in society and we have a duty to ensure they are safeguarded. If the report is wrong and the claims exaggerated then I agree, it’s poor reporting, but we need to know for sure before the second wave or the next pandemic.

I'm more concerned about the lack of care which was shown to people in care homes (not, I stress, by the care workers on the front line), which in some cases undoubtedly hastened death than I am about lack of DNRs.

I agree growstuff. Sadly I fear that any Inquiry about the inadequate response to the coronavirus outbreak, notably in Care Homes, will go the way of other Inquiries, ie kicked down the road until it eventually appears in a redacted form and people will have lost interest.
DNR is another separate issue.

There have been CCGs writing to care homes instructing them to get every resident to sign a DNR form, and also instructing them that they are not allowed to send their residents into hospital, for what ever reason that they might need it. That did happen in Port Talbot with their local authority too.

I would be happy to sign that I did not want cardiac compressions, but I would not be happy to sign that I didn't want to be put on a drip, or antibiotics if I got a chest infection, which is what the decision is taken to mean in some cases. Many years ago as a student nurse I refused to agree to an old man, successfully treated for cancer, not being given antibiotics for his chest infection because the rest of the staff thought he had lived long enough. Everyone had to agree, so he got his treatment, recovered, and went off to marry his girlfriend at the age of 82!

In emergency circumstances bad decisions and directives do arise, and yes, there most certainly needs to be an enquiry. No-one should feel under pressure to sign that they don't want further treatment, it should be a sensitive conversation between patient, carers, and relatives if they are contactable. There are recorded instances where this hasn't happened, and better guidance needs to be forthcoming.

B9exchange

In my area, we address this by having something called Goals of Care. When a patient enters hospital, the provider is to have a discussion with them regarding Goals of Care, and these can be changed as necessary. There are seven levels:

R (resuscitative care) 1 - everything
R2 - no chest compressions
R3 - no intubation
M (medical care) 1 - DNR, no ICU admission, may be admitted to acute care, may have surgery done, continue to treat active medical conditions
M2 - similar to M1 except surgery for comfort only
C (comfort care) 1 - admit to acute care for symptom control only, surgery for symptom control only, no longer treating active medical conditions, treat for comfort only
C2 - treat symptoms for comfort only, no surgery, no admission to hospital (for patients in last days of life)

This document is placed in a green sleeve, along with other documents in this vein such as power of attorney, personal directive naming a substitute decision maker, etc. When the patient is discharged, all documents in the green sleeve are photocopied, and the originals are given back to the patient. The patient is told to keep the green sleeve on their fridge. Should they have an emergency and need to call EMS, EMS knows to look on the fridge for the green sleeve and they'll honour the Goals of Care decision. (EMS now has treat in place protocols for situations such as palliative emergencies.)

agnurse- the way it should be. People should talk and make their choices clear- just cannot understand why couples, families, don't do that.