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CQC to review blanket DNR orders during pandemic

Assisted dying

The CQC has announced an investigation into the use of blanket ‘do-not-resuscitate’ (DNR) orders in primary care as well as care homes and hospitals. 

This follows concerns that elderly and vulnerable people were subject to DNR decisions without their consent or informed choice earlier on in the Covid-19 pandemic, the regulator said.

The review will look to identify and share best practice around DNR and identify where decisions may not have been patient-centred.  

Interim findings are expected to be reported later this year with a final report early next year.

DNR orders can allow individuals to make a shared decision about what intervention they would like if they suffer cardiac or respiratory arrest, including refusing resuscitation. 

Announcing the review, CQC chief inspector of primary care Dr Rosie Benneyworth said it is ‘unacceptable’ for DNR decisions to be applied to a group of people and that they ‘must continue to be made on an individual basis’.  

She continued: ‘It is vital that we take this opportunity to learn from what has happened – challenging poor care and sharing the ways that providers have put people’s needs at the heart of their care so that others can learn from them.’ 

Both staff and patients’ families had raised concerns about care to the CQC, she added. 

In April, NHS England asked GPs and other healthcare professionals to avoid any ‘blanket’ policies on clinical decisions during the pandemic, especially with regards to DNR forms.

The guidance came as hundreds of GP practices in North West London were advised to tell the relatives of care home patients who lack capacity that ‘difficult decisions’ will need to be made around admitting these patients to hospital.

Also in April, the CQC published a joint statement with the BMA and RCGP which declared it unacceptable for advanced care plans to be applied to groups of people.