Unified DNACPR strategy - South Central Strategic Health Authority

DIFFUSION/CULTURE

WHAT IS THE ISSUE?

Development and implementation of a DNACPR strategy is a core component of End of Life Care and aligns precisely with national guidelines. There is clear need for a seamless cross-sector and multi-organisational end of life care planning and management strategy.

WHAT IS THE INNOVATION?

NHS South Central have been developing a unified Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) strategy over the last year. It has approval from all nine Acute Trusts, and all nine PCTs in South Central. The project's aim is to deliver the DNACPR strategy in a supported package for service that will deliver a common policy, education and accompanying documentation that crosses all boundaries. This will be the first time a policy has been agreed across all sectors and settings including care homes and third sector. The successful roll out of the DNACPR policy across sectors and settings will act as a model for the overall implementation of the End of Life Care (EoLC) programme and will inform the implementation of other SHA work.

In its final form, it is envisaged that an electronic information system populated with people's wishes and advance directives / care plans would facilitate the sharing of records across all sectors and settings in the South Central SHA.

WHAT IS THE BENEFIT?

For patients/staff/service

• Improved patient and carer experience.
• Increased patient choice and satisfaction regarding end of life planning.
• DNACPR decisions respected across all sectors and settings.
• Staff empowered to work in the best interest of patients.
• Staff educated in decision making, writing and communicating DNACPR decisions.

Increased quality and productivity

• Reduction in inappropriate emergency admissions to hospital.
• Reduction in complaints and associated costs.
• Increased patient satisfaction from EoLC choice.
• Reduced bereavement complications for relatives/loved ones.

Spread and sustainability

• Supported by all Acute Trusts and PCTs in South Central.
• NHSLA to audit Trust DNACPR policies and decisions.
• DNACPR to become part of general EoLC training.
• Complies with PCT legal and governance framework.
• Regional and national events and engagement to communicate work and share lessons.

Projected savings

• Reduction in cost of complaints – per trust per annum £1,110,150. Up to 50% of complaints relate to EoLC.
• Of £1.8billion annual spend treating cancer patients in last year of life National Audit Office calculates £104million could be redistributed to meet peoples care preferences by reducing hospital admissions by 10% and average length of stay following admission by 3 days.
• Reduction in cost of complaints.