Review of DNACPR orders within the coordinate my care (CMC) system during the first wave of the COVID-19 pandemic

ABSTRACT

CMC is an NHS service to support urgent and advanced care planning for frail and palliative patients and patients with complex and life-limiting conditions. CMC's consent model ensures that no decisions about a patient's treatment - including 'Do Not Attempt Cardio-Pulmonary Resuscitation' (DNACPR) decisions - are made without the patient and, where appropriate, a loved one. We assess if there was a change in the way patients were consented and had DNACPR orders recorded during the first wave of Covid-19 by reviewing 107,614 published CMC care plans. Overall, 68% of care plans were created with the direct consent of the patient, 6% with the consent of and Lasting Power of Attorney (LPA) and 26% in the patient's best interest providing clear justifications for the decision. Although we observed an increase in patients added to CMC in the first wave of Covid-19, the consent pattern remained consistent with pre-Covid data. CPR decisions were added to 27,161 CMC care plans between March and September 2020, 15,898 (59%) of which were recorded with DNACPR decisions. Of these, 52% were recorded as having the mental capacity to discuss the decision (consistent with pre- Covid data) and 37% as not having the capacity to discuss. 29% were recorded for resuscitation, which is more than the same decision in pre- Covid-19 data (18%). During first wave of Covid-19, 90% of care plans show a clear yes/no CPR decision, compared to 88% Pre-Covid-19. Of the CMC care plans which included DNACPR during the first wave of pandemic and where no mental capacity was indicated, all provide supporting information on discussions with family/LPA. We conclude that, with the right systems in place, conversations about advance care planning took place and were recorded on CMC. Embedding personalised advanced care planning into the standard health care practice enables bespoke patient-centred care, even during the pandemic.