ReSPECT: Frequently asked questions on version 3 for adopters

Since introducing the ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) process in 2016, Resuscitation Council UK (RCUK) has continued to support its evolution and the improvement of the documentation that supports the process.

From Wednesday 16th September, version 3 of the form has been available for you to use.

RCUK has produced this information resource to help adopters like you to embed the new version of the ReSPECT form into your practice.

Frequently asked questions

If you are a healthcare organisation wishing to adopt ReSPECT in your locality, please contact info@respectprocess.org.uk.

We made changes to the form following individual and focus group feedback from adopter leads, clinicians, patients and the public. 
 
The changes have been designed to improve the conversation between a person and their healthcare professional, improve documentation of clinical reasoning and of patient values and preferences, as well as ensure consistency of documentation.

The changes between version 2 and version 3 of the form are summarised below:

What you will see in version 3 Reason for the change

Inclusion of a statement about the process being based around a conversation. 

States that the recorded recommendations are not legally binding.

Puts the focus on the conversation and the individual’s perspective.

Makes clearer to the user the recorded recommendations are not legally binding. 

Changes to the wording in section 2 to encourage clinicians to record information about the person’s personal circumstances. Section is now called ‘Shared understanding of my health and current condition’.

The question about whether the person has a legal proxy has been moved from the back of the form to the front in section 2. 

Puts more emphasis on shared understanding of the situation between the professional and patient.

 


Enables recording earlier in the process of whether the person has a legal proxy. 
 

The scale in section 3 ‘What matters to me in decisions about my treatment and care in an emergency’ has been converted to a visual aid. In the previous version people were given an option to mark on the scale where they viewed their wishes between prioritising sustaining life and prioritising comfort.  This caused some confusion to people and often they did not complete this section.
In section 3 ‘What matters to me in decisions about my treatment and care in an emergency’, the patient is now asked what they most value and what they fear most/wish to avoid. This is important information that supports better understanding of the patient and their needs, and clearer recording of what matters to them.
In section 4 ‘clinical recommendations for emergency care and treatment’, the language has been made more personable. Feedback from patients and the public highlighted the need for more personable language.
In section 4 ‘clinical recommendations for emergency care and treatment’ a third option has been made available – the ability to record a clinical recommendation to balance extending life with comfort and valued outcomes. This additional option reflects the fact that for some patients, based on their values, a balanced approach will be the recommendation. Feedback was that the previous form gave the impression that the clinician needed to make a binary decision which often did not reflect the patient’s realistic preferences.
In section 5 ‘Capacity for involvement in making this plan’ the wording has been changed to ensure that when decisions are made without involving the patient, the reasons for this are clearly recorded. There is also an important reminder that if the person lacks capacity a ReSPECT conversation must take place with the legal proxy and/or family.

Provides clearer wording to encourage clinicians to record clearly in what way the person lacks capacity and the reason why the patient wasn’t involved in the conversation. 

The reminder about involving the legal proxy and/or family will help ensure that the legal proxy and/or family is always involved in making best-interest decisions when the patient lacks mental capacity for those decisions.

The option for patient/legal proxy or family member to sign the document to allow them to show they have been actively involved in the discussion and recommendations about their/their family member’s care and treatment. We had received feedback from some patients, families and clinicians that they would value the ability for a person/their legal proxy or family member to sign the document to confirm their involvement in the conversation and recorded recommendations.

In section 2, we no longer mention organ donation. The reason for this is that the law has changed in England to an Opt Out system and is changing in Scotland.  While it is still an individual’s choice whether to donate or opt out, it is better for people to record their decision, whatever it is and wherever they live in the UK, on the NHS Organ Donor Register. This Register is accessed by specialist organ donation staff before they approach the family, to check if an organ donation decision had been recorded by the individual. 

No, this is optional. This section has been introduced in response to feedback from professionals and patients, but we appreciate that not all patients/legal proxy or family members will want to sign it. 

We encourage you to offer patients/family members this option, but without pressurising them to do so. The option for patient/legal proxy or family member to sign the document if they wish, allows all those involved to demonstrate that the patient, or their legal proxy and/or a family member has been actively involved in the discussion and recommendations about the person’s care and treatment. 

The signatures do not make the recommendations on the form legally binding and it is important that patients/family members are made aware of this, as this is a common misunderstanding. 

The professional’s signature confirms that they are taking responsibility for adhering to best practice in following the ReSPECT process and for complying with capacity and human rights legislation. 

Yes. When the ReSPECT process is used and the form is completed, it’s important for professionals and patients to remember that this form will be used in an emergency by other professionals, such as ambulance crews, care home staff and out-of-hours doctors.  

So, we ask that you complete it thoroughly to ensure that conversations and recommendations are recorded accurately and clearly before it is placed in use. We recognise that completing the form in one go may not be possible and several conversations may need to take place over a period of time before it is placed in use.

RCUK will be officially launching version 3 of the ReSPECT form on Wednesday 16 September 2020 and we are encouraging existing adopter communities/organisations to use the form from that date, as soon as it is practical to do so. We recommend this is done once you are confident that you have informed all the users in your area about the new form and that your colleagues have had the resources and training they need to successfully embed the new form into their practice. 

Yes. As before, you will need to arrange printing of the form yourselves using your own suppliers. 

While RCUK did temporarily help with printing at the height of the COVID-19 pandemic by giving adopters access to our printer company, this was a temporary arrangement due to many other printer companies being closed.

No, they don’t. Any previously recorded conversations and recommendations using the ReSPECT process can still be used to guide clinical decision making in an emergency.  When there is next contact between the clinician and patient, that can be used as an opportunity to check whether all the details on their form remain current, and to transfer full and up-to-date details on to a version 3 form.

Yes, they can, but we encourage you to start using version 3 across your area as soon as is practically possible as the changes have been made based on feedback from professionals, patients and their families. These changes have been made to support better conversations and to record that discussion and the resulting recommendations more accurately.  

We appreciate that some areas may prefer to use existing version 2 forms first before rolling out version 3.  We ask that you weigh up the right approach for your area, factoring in resourcing and the communications and training required to introduce version 3. You may decide that, despite a recent print run, you would prefer to discard of that stock and introduce version 3 as soon as possible, as it has been developed to support a better conversation and documentation, informed by feedback on the process. 

This will depend entirely on the platform in use and the way in which the ReSPECT form has been digitised within the system.  If you are unsure about this, please contact us and we can connect you with other organisations using the same platform or give you more specific guidance.

This will depend entirely on the platform in use and the way in which the ReSPECT form needs to be digitised within the system.  If you are unsure about this, please contact us and we can connect you with other organisations using the same platform or give you more specific guidance.

We will make a survey available on our website to capture experiences of using the form, specifically focusing on the changes that have been made, and will let you know when it is live.  We are not making the survey available immediately as we would like professionals and patients to complete it based on their experience of having and recording ReSPECT conversation(s) using the new form. 

We anticipate the survey will go live on 7 October and we will let you know when it is available. We ask that you encourage people in your area to complete it to provide us with their feedback on using version 3. The feedback will help us to understand whether the changes we have made have improved the conversation and experience as we expect it to and help us to identify any unforeseen issues when the form is used in practice.

Yes, we will make an audit tool available, but do not yet have a date confirmed for when we will issue it. We will provide the audit tool and instructions in advance of you needing to audit.  Audit and evaluation of the ReSPECT process are essential to ensure it is embedded into your local clinical governance structures and we would encourage you to consider embedding version 3 of the form within a Quality Improvement framework.