#WeLDNs - Tuesday 23rd February 2021 8:30pm (GMT Standard Time) Misuse of DNACPR orders

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Due to the publication of an article last week highlighting that people with learning disabilities are still having Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders put in place inappropriately, at @WeLDNurses we felt we should continue the conversation. 

This horrifying practice was seen at the start of the pandemic with blanket DNACPR orders being placed across groups of individuals diagnosed with a learning disability despite clear guidance being published from the British Medical Association (BMA), the Resuscitation Council – UK, General Medical Council (GMC) and the Nursing and Midwifery Council (NMC).

With data being published last week from the Office of National Statistics (ONS) showing that people with learning disabilities are 3.7 times more likely to die from Covid-19 compared to the general population, it is more crucial than ever that we challenge poor practice and ensure we are enabling people with a learning disability to have the best health outcomes and experience through care.   

The LeDeR review into deaths of people with a learning disability from Covid-19 published in September 2020 outlined a broad theme of the need for people with a learning disability, their family and carers to be involved in DNACPR decisions with accompanying full documentation and handover of this information. Reviewers found that in some cases ‘frailty’ or ‘learning disability’ were given as a rationale for a DNACPR being in place as well as a lack of evidence of capacity considerations.

The Department of Health and Social Care agree that the inappropriate use of DNACPR throughout the pandemic has been “completely unacceptable” and have asked the Care and Quality Commission (CQC) to undertake a review of all DNACPR notices applied to individuals with a learning disability through the Covid-19 pandemic.

Good practice has been identified with Learning Disability England and Turning Point creating a support pack (available through the link below) and the General Practitioner (GP) contract for 2020-2021 including the need for all DNACPR orders to be reviewed for patients registered with a learning disability. But is this enough?

Join us on Tuesday 23rd February at 20:30 using #WeLDNs to discuss the misuse of DNACPR orders throughout the Covid-19 pandemic for people with a learning disability, discuss what we can learn from this and how we can prevent this horrendous practice happening in the future. 


References and suggested reading:

https://www.turning-point.co.uk/DNACPR

https://www.theguardian.com/world/2021/feb/13/new-do-not-resuscitate-orders-imposed-on-covid-19-patients-with-learning-difficulties?CMP=Share_AndroidApp_Other&fbclid=IwAR3vnQtWmshA7-bGZym3OQZ7xV4-SqqyiwRBPAnVdZsFtbbqRq6cWYGcbPk

https://www.ons.gov.uk/releases/updatedestimatesofcoronaviruscovid19relateddeathsbydisabilitystatusenglandandwales2marchto20november2020

http://www.bristol.ac.uk/media-library/sites/sps/leder/Deaths%20of%20people%20with%20learning%20disabilities%20from%20COVID-19.pdf

https://www.england.nhs.uk/wp-content/uploads/2020/11/C0843-Covid-LeDeR-report-131120.pdf

https://www.england.nhs.uk/publication/covid-19-deaths-of-patients-with-a-learning-disability-notified-to-leder/

https://www.cqc.org.uk/news/stories/reviewing-use-do-not-resuscitate-decisions-during-covid-19





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 #WeLDNs transcript

 
@WeLDnurses
23 February 2021 20:30
Good evening everyone! Welcome to tonight’s chat. Let’s start with a round of hello’s ???? #WeLDNs
@salsa442
23 February 2021 20:30
Hi all, Sal here #waving from Leicester #WeLDNs
@WeLDnurses
23 February 2021 20:31
@salsa442 Evening Sal! #WeLDNs
@samabdulla
23 February 2021 20:31
@WeLDnurses Hiya folks! #weldns
@WeLDnurses
23 February 2021 20:32
@samabdulla Hi Sam! #WeLDNs
@WeLDnurses
23 February 2021 20:32
@walsinghamuk Good evening! Great to have you with us! #WeLDNs
@WeLDnurses
23 February 2021 20:33
@steve_grimbleby Evening Steve! Good to have you join us #WeLDNs
@florenceella
23 February 2021 20:34
@WeLDnurses Evening all! Flo here in a windy Birmingham! ???? #WeLDNs
@WeNurses
23 February 2021 20:34
Really interesting #WeLDNs just starting > https://twitter.com/WeLDnurses/status/1364131217893908487
@WeLDnurses
23 February 2021 20:34
@AmySmith_5 Evening! #WeLDNs
@LuBrenda3
23 February 2021 20:34
RT @WeLDnurses: Good evening everyone! Welcome to tonight’s chat. Let’s start with a round of hello’s ???? #WeLDNs
@salsa442
23 February 2021 20:34
@florenceella @WeLDnurses The wind is howling here too! #WeLDNs
@WeLDnurses
23 February 2021 20:35
So let’s get started with the first question - what experience do you have with DNACPR orders? #WeLDNs
@WeLDnurses
23 February 2021 20:36
@nicola19304381 Good evening! #WeLDNs
@salsa442
23 February 2021 20:36
RT @WeNurses: Really interesting #WeLDNs just starting >
@samabdulla
23 February 2021 20:36
RT @WeLDnurses: So let’s get started with the first question - what experience do you have with DNACPR orders? #WeLDNs
@LuBrenda3
23 February 2021 20:37
@WeLDnurses @WeLDnurses Good evening, hey ?? #weLDNs
@salsa442
23 February 2021 20:37
Where I am we use ReSPECT forms so have advanced care plan component as well as the DNACPR #WeLDNs https://twitter.com/weldnurses/status/1364312987952103426
@samabdulla
23 February 2021 20:38
@WeLDnurses Limited to be honest, both as practionner and also reflectively as an educator #weldns
@samabdulla
23 February 2021 20:38
@salsa442 What’s the ReSPECT form Sal? #weldns
@WeLDnurses
23 February 2021 20:38
RT @salsa442: Where I am we use ReSPECT forms so have advanced care plan component as well as the DNACPR #WeLDNs
@WeLDnurses
23 February 2021 20:40
Does anyone else have experience with ReSPECT forms? #WeLDNs https://twitter.com/salsa442/status/1364313516119834631
@salsa442
23 February 2021 20:40
@samabdulla This is what we use Sam https://www.resus.org.uk/respect #WeLDNs
@nursingld
23 February 2021 20:40
@WeLDnurses I’ve reviewed the use of them for LeDeR #weldns
@samabdulla
23 February 2021 20:41
@salsa442 Thanks so much! This will be super helpful! #weldns
@samabdulla
23 February 2021 20:41
RT @salsa442: @samabdulla This is what we use Sam https://www.resus.org.uk/respect #WeLDNs
@WeLDnurses
23 February 2021 20:41
@nursingld What kind of things do you look for when reviewing them @nursingld ? #WeLDNs
@WeLDnurses
23 February 2021 20:41
RT @salsa442: @samabdulla This is what we use Sam https://www.resus.org.uk/respect #WeLDNs
@drliberty
23 February 2021 20:41
@WeLDnurses We have them in place alongside hospital passports and other plans for accessing healthcare #weldns
@salsa442
23 February 2021 20:42
@samabdulla I really wasn’t sure about them when we first started to use them, but there’s elements of this process I find really useful and helpful #WeLDNs
@WeLDnurses
23 February 2021 20:42
RT @drliberty: @WeLDnurses We have them in place alongside hospital passports and other plans for accessing healthcare #weldns
@nursingld
23 February 2021 20:42
@WeLDnurses Did the person have capacity to consent, were next of kin consulted or an advocate. What was the reason for DNACPR eg legitimate reason and not ‘learning disability’ and whether documentation was completed correctly #weldns
@samabdulla
23 February 2021 20:43
@salsa442 I wonder if they are applied here. Might need to check that out with our service partners #weldns
@WeLDnurses
23 February 2021 20:43
@salsa442 @samabdulla Would you be able to share some of the elements you find useful @salsa442 ? #WeLDNs
@nursingnoodle
23 February 2021 20:43
RT @WeLDnurses: So let’s get started with the first question - what experience do you have with DNACPR orders? #WeLDNs
@WeLDnurses
23 February 2021 20:44
Are you aware that there is evidence of inappropriate application of DNACPR orders through the Covid-19 pandemic? #WeLDNs
@Helen_OTUK
23 February 2021 20:45
RT @WeLDnurses: Are you aware that there is evidence of inappropriate application of DNACPR orders through the Covid-19 pandemic? #WeLDNs
@steve_grimbleby
23 February 2021 20:45
@WeLDnurses There has been quite a lot in the news about this #WeLDNs
@samabdulla
23 February 2021 20:45
This misapplication of DNACPR through the pandemic (and outside of it if we are being totally honest) is criminal #weldns https://twitter.com/weldnurses/status/1364315133288321035
@salsa442
23 February 2021 20:45
@WeLDnurses @samabdulla For me it’s the ability for all people to personalise their care plans and it supports clinicians to have those conversations #WeLDNs https://t.co/1kRCVliK1X
@WeLDnurses
23 February 2021 20:45
RT @samabdulla: This misapplication of DNACPR through the pandemic (and outside of it if we are being totally honest) is criminal #weldns
@florenceella
23 February 2021 20:46
RT @samabdulla: This misapplication of DNACPR through the pandemic (and outside of it if we are being totally honest) is criminal #weldns
@florenceella
23 February 2021 20:46
@samabdulla Absolutely shocking #WeLDNs
@SueMarsden6
23 February 2021 20:47
#WeLdns https://twitter.com/suemarsden6/status/1364315789503983617
@WeLDnurses
23 February 2021 20:47
@SueMarsden6 Was this specific to the pandemic @SueMarsden6, and what kind of things did it cover? #WeLDNs
@salsa442
23 February 2021 20:48
Yes, it’s been reported in the media regarding people with learning disabilities and elderly people and people with dementia #WeLDNs https://twitter.com/weldnurses/status/1364315133288321035
@steve_grimbleby
23 February 2021 20:48
@samabdulla @WeLDnurses It has to be direct discrimination #WeLDNs
@salsa442
23 February 2021 20:48
RT @samabdulla: This misapplication of DNACPR through the pandemic (and outside of it if we are being totally honest) is criminal #weldns
@WeLDnurses
23 February 2021 20:48
Thanks for sharing @salsa442 #WeLDNs https://twitter.com/salsa442/status/1364315553687629828
@samabdulla
23 February 2021 20:48
@SueMarsden6 What goes into this training #weldns
@samabdulla
23 February 2021 20:48
@steve_grimbleby @WeLDnurses I think it’s tough to see it as anything but #weldns
@WeLDnurses
23 February 2021 20:48
RT @steve_grimbleby: @samabdulla @WeLDnurses It has to be direct discrimination #WeLDNs
@SueMarsden6
23 February 2021 20:48
@salsa442 @WeLDnurses #weLDNs I am just learning about using ReSPECT as it’s not used in my old locality.
@dan_scorer
23 February 2021 20:50
RT @samabdulla: This misapplication of DNACPR through the pandemic (and outside of it if we are being totally honest) is criminal #weldns
@salsa442
23 February 2021 20:50
@SueMarsden6 @WeLDnurses Once you get used to the format, it’s actually quite user friendly and person centred #WeLDNs
@samabdulla
23 February 2021 20:50
@salsa442 @WeLDnurses I really like the language used here #weldns
@SueMarsden6
23 February 2021 20:50
@WeLDnurses #weLDNs, yes it was in response to the pandemic, and recognition of the need for appropriate use. Had that sense that some people with particular comorbidities would have v poor outcomes from #Covid19
@WeLDnurses
23 February 2021 20:51
Next question: Would you feel comfortable challenging a DNACPR order if you believed it to be in place inappropriately? For example ‘learning disability’ stated as reason #WeLDNs
@steve_grimbleby
23 February 2021 20:51
@samabdulla @WeLDnurses All DNACPR decisions should be by informed consent. Has the issue of people with learning disabilities been put on DNACPR been around for long #WeLDNs I worked in a learning disabilities project 20 years ago and r about it
@SueMarsden6
23 February 2021 20:51
@WeLDnurses #WeLDNs but not just to do with pandemic, so my usual caseload of EOLC peeps have benefitted from better DNACPRS
@WeLDnurses
23 February 2021 20:51
RT @SueMarsden6: @WeLDnurses #weLDNs, yes it was in response to the pandemic, and recognition of the need for appropriate use. Had that sen…
@Vuyiswa72340752
23 February 2021 20:52
@WeLDnurses Hello everyone just joined the chat #WeLDNs
@salsa442
23 February 2021 20:52
@samabdulla @WeLDnurses Me too, and when clinicians really use it well it gives people some control of their care going forwards and it’s really supportive of some difficult clinical conversations #WeLDNs
@samabdulla
23 February 2021 20:52
@steve_grimbleby @WeLDnurses I agree entirely, I agree with the principles behind the process, it’s the application that’s not right #weldns
@SueMarsden6
23 February 2021 20:52
@samabdulla #WELDNs.. an understanding of ordinary dying, and the reasons for putting in a DNACPR, the legalities, how to write them, who to consult and when.
@WeLDnurses
23 February 2021 20:53
@Vuyiswa72340752 Good evening! Thanks for joining us #WeLDNs
@WeLDnurses
23 February 2021 20:53
Giving control and independence seems to be a common theme appearing here #WeLDNs https://twitter.com/salsa442/status/1364317279601704962
@steve_grimbleby
23 February 2021 20:53
@samabdulla @WeLDnurses All DNACPR decisions should be by informed consent. Has the issue of people with learning disabilities been put on DNACPR been around for long #WeLDNs I worked in a learning disabilities project 20 years ago and never heard anything about it
@SueMarsden6
23 February 2021 20:54
@WeLDnurses #WELDNs yes absolutely.
@samabdulla
23 February 2021 20:54
@WeLDnurses For me, the ability to challenge is more complex than we give credit. It’s something we just expect people to be able to do #weldns
@drliberty
23 February 2021 20:54
@WeLDnurses #WeLDNs yes definitely
@WeLDnurses
23 February 2021 20:55
@SueMarsden6 That’s great news, how would you go about it/ what advice would you give someone who was less confident? #WeLDNs
@LuBrenda3
23 February 2021 20:55
@WeLDnurses Yes,We all human beings we all have the same right it's does not matter about any disability as reason #WeLDNs
@salsa442
23 February 2021 20:55
Absolutely yes, have done it many times and will continue to challenge when I think it is appropriate #WeLDNs https://twitter.com/weldnurses/status/1364316915632644096
@SueMarsden6
23 February 2021 20:56
@WeLDnurses #weLDNs I think it’s massively important that it’s understood as one part of care available, and a #DNACPR doesn’t mean no treatment. When used correctly I agree with @salsa442 it can quite liberating.
@WeLDnurses
23 February 2021 20:56
How can we support people to feel more able to challenge? #WeLDNs https://twitter.com/samabdulla/status/1364317681873281028
@samabdulla
23 February 2021 20:57
RT @salsa442: Absolutely yes, have done it many times and will continue to challenge when I think it is appropriate #WeLDNs
@WeLDnurses
23 February 2021 20:57
@CanvasCharlie Hi Charlie! Please don’t forget to use #WeLDNs in your tweets so we don’t miss your great contributions!
@salsa442
23 February 2021 20:57
@samabdulla @WeLDnurses It’s hard at times for sure, but there is never a justification for “learning disability” being a reason not to provide CPR and we have a duty to challenge this #WeLDNs
@WeLDnurses
23 February 2021 20:57
This! #WeLDNs https://twitter.com/lubrenda3/status/1364318062523072516
@WeLDnurses
23 February 2021 20:57
RT @salsa442: Absolutely yes, have done it many times and will continue to challenge when I think it is appropriate #WeLDNs
@WeLDnurses
23 February 2021 20:58
RT @SueMarsden6: @WeLDnurses #weLDNs I think it’s massively important that it’s understood as one part of care available, and a #DNACPR doe…
@samabdulla
23 February 2021 20:58
@salsa442 @WeLDnurses I agree, it’s wonder sometimes if we create cultures where challenge can be more difficult #weldns
@steve_grimbleby
23 February 2021 20:58
@samabdulla @WeLDnurses Can be very difficult to speak up in front of people. But we must advocate for our patients #WeLDNs
@SueMarsden6
23 February 2021 20:59
@WeLDnurses #WeLDNs interesting question! Curious questioning I find is helpful...”hello, can you explain to me why Bobs learning disability would be a reason to not resuscitate him?...I’m struggling to understand”....
@RebeccaCrossle2
23 February 2021 20:59
#WeLDNs very very late will have to catch up
@salsa442
23 February 2021 20:59
@SueMarsden6 @WeLDnurses It really can, and the ReSPECT form makes it clear that it is just once component of care (CPR) and it other components of care (Abx, O2, IVs etc) are to continue #WeLDNs
@WeLDnurses
23 February 2021 21:00
Curious questioning is a great tool #WeLDNs https://twitter.com/suemarsden6/status/1364318900427644931
@salsa442
23 February 2021 21:00
@samabdulla @WeLDnurses Yes this may well be true #WeLDNs
@Vuyiswa72340752
23 February 2021 21:00
@salsa442 I find it very sad and dicriminating against people with learning disability that learning disability alone can be reason for DNACPR #WeLDNs
@salsa442
23 February 2021 21:00
#WeLDNs https://twitter.com/rebeccacrossle2/status/1364319095529873410
@WeLDnurses
23 February 2021 21:00
@RebeccaCrossle2 Good evening! Better late than never eh! The transcript will always be available following the chat #WeLDNs
@WeLDnurses
23 February 2021 21:01
RT @samabdulla: @salsa442 @WeLDnurses I agree, it’s wonder sometimes if we create cultures where challenge can be more difficult #weldns
@RebeccaCrossle2
23 February 2021 21:01
I'm using the clinic to promote these conversations every person everytime #weldns https://twitter.com/salsa442/status/1364318973668569090
@steve_grimbleby
23 February 2021 21:01
RT @WeLDnurses: How can we support people to feel more able to challenge? #WeLDNs
@steve_grimbleby
23 February 2021 21:01
RT @SueMarsden6: @WeLDnurses #WeLDNs interesting question! Curious questioning I find is helpful...”hello, can you explain to me why Bobs l…
@WeLDnurses
23 February 2021 21:01
What is everyone’s thoughts on this? #WeLDNs https://twitter.com/samabdulla/status/1364318687038238723
@salsa442
23 February 2021 21:01
@Vuyiswa72340752 It can’t, it never should be given as a reason for DNACPR, and if it is, this needs to be challenged #WeLDNs
@LuBrenda3
23 February 2021 21:01
@WeLDnurses It's our responsibility to challenge so everyone can be equal regardless they're disability #weLDNs
@WeLDnurses
23 February 2021 21:01
Who should be involved in the decision to have a DNACPR in place? #WeLDNs
@RebeccaCrossle2
23 February 2021 21:01
RT @salsa442: #WeLDNs
@salsa442
23 February 2021 21:01
RT @RebeccaCrossle2: I'm using the clinic to promote these conversations every person everytime #weldns
@SueMarsden6
23 February 2021 21:02
@WeLDnurses #WeLDNs I think it also enables us to then answer some of concerns a medic might have, like explaining quality of life, or the support available to get someone through a prolonged recovery. Equally it may help us understand why it’s appropriate, and then to re-word it.
@WeLDnurses
23 February 2021 21:02
RT @salsa442: @Vuyiswa72340752 It can’t, it never should be given as a reason for DNACPR, and if it is, this needs to be challenged #WeLDNs
@steve_grimbleby
23 February 2021 21:02
RT @WeLDnurses: Giving control and independence seems to be a common theme appearing here #WeLDNs
@samabdulla
23 February 2021 21:02
@WeLDnurses The person with the learning disability, the people who mean the most to them and the clinical team. #weldns
@steve_grimbleby
23 February 2021 21:02
RT @SueMarsden6: @WeLDnurses #weLDNs I think it’s massively important that it’s understood as one part of care available, and a #DNACPR doe…
@salsa442
23 February 2021 21:02
This ???? #WeLDNs https://twitter.com/suemarsden6/status/1364318900427644931
@WeLDnurses
23 February 2021 21:02
And what should the process of decision making be? #WeLDNs
@WeLDnurses
23 February 2021 21:03
RT @samabdulla: @WeLDnurses The person with the learning disability, the people who mean the most to them and the clinical team. #weldns
@LuBrenda3
23 February 2021 21:03
@WeLDnurses Service user #weLDNs
@WeLDnurses
23 February 2021 21:03
RT @SueMarsden6: @WeLDnurses #WeLDNs I think it also enables us to then answer some of concerns a medic might have, like explaining quality…
@steve_grimbleby
23 February 2021 21:03
RT @WeLDnurses: Who should be involved in the decision to have a DNACPR in place? #WeLDNs
@steve_grimbleby
23 February 2021 21:03
RT @samabdulla: @WeLDnurses The person with the learning disability, the people who mean the most to them and the clinical team. #weldns
@nursingnoodle
23 February 2021 21:04
RT @WeLDnurses: How can we support people to feel more able to challenge? #WeLDNs
@salsa442
23 February 2021 21:04
The person and the treating clinician primarily. DNACPR has to be clinically led, if CPR isn’t going to work due to clinical co-morbidities then it’s not in a persons best interests. If the person can’t consent then needs NoK and Best Interests process #WeLDNs https://twitter.com/WeLDnurses/status/1364319564306219010
@WeLDnurses
23 February 2021 21:05
@LearningDisEng and @TurningPointUK have developed this pack to support with DNACPR orders #WeLDNs https://www.turning-point.co.uk/DNACPR
@KKessack
23 February 2021 21:05
RT @WeLDnurses: Thanks for sharing @salsa442 #WeLDNs
@florenceella
23 February 2021 21:05
RT @WeLDnurses: @LearningDisEng and @TurningPointUK have developed this pack to support with DNACPR orders #WeLDNs https://www.turning-point.co.uk/DNACPR
@KKessack
23 February 2021 21:05
RT @salsa442: Where I am we use ReSPECT forms so have advanced care plan component as well as the DNACPR #WeLDNs
@florenceella
23 February 2021 21:05
RT @RebeccaCrossle2: I'm using the clinic to promote these conversations every person everytime #weldns
@florenceella
23 February 2021 21:05
RT @SueMarsden6: @WeLDnurses #WeLDNs interesting question! Curious questioning I find is helpful...”hello, can you explain to me why Bobs l…
@WeLDnurses
23 February 2021 21:06
RT @RebeccaCrossle2: I'm using the clinic to promote these conversations every person everytime #weldns
@samabdulla
23 February 2021 21:07
RT @WeLDnurses: @LearningDisEng and @TurningPointUK have developed this pack to support with DNACPR orders #WeLDNs https://www.turning-point.co.uk/DNACPR
@RebeccaCrossle2
23 February 2021 21:07
To go through the respect process to ensure people understand the decisions to be made using media appropriate for the person and include IMCA as per MCA before an emergency arises maybe at annual #healthcheck #advanceddecisions #weldns https://twitter.com/WeLDnurses/status/1364319862005374976
@SueMarsden6
23 February 2021 21:07
@salsa442 @WeLDnurses Interesting thought... if it’s not clinically indicated ie it has no chance of success then I’m not sure it’s a consent/bi issue. If it’s about quality of life and might successful then defo about consent. Happy to be challenged on this. #WeLDNs
@WeLDnurses
23 February 2021 21:08
What’s everyone’s thoughts? #WeLDNs https://twitter.com/suemarsden6/status/1364321032300093440
@salsa442
23 February 2021 21:08
In the event the persons heart stops, is CPR likely to re-start it? Do they have a clinical condition and/or co-morbidities that reduce the likelihood of CPR being successful? What does the person want to happen? #WeLDNs https://twitter.com/weldnurses/status/1364319862005374976
@drliberty
23 February 2021 21:08
@WeLDnurses #weldns we live in a culture where where there is no acceptance of challenge - you are either right or wrong - as LD nurses we are curious souls so can question and rethink and need to lead culture change in this way
@salsa442
23 February 2021 21:10
@SueMarsden6 @WeLDnurses Clinical indication is paramount - if no chance of success then it should be recorded as DNACPR - clinically led decision, so yes I agree with you entirely and sorry if I wasn’t clear #WeLDNs
@WeLDnurses
23 February 2021 21:10
@JayneTh81981374 That’s great, how did you go about this ? Any tips for others? #WeLDNs
@SueMarsden6
23 February 2021 21:10
@WeLDnurses #WeLDNs is this part of a natural process of irreversible dying?
@WeLDnurses
23 February 2021 21:10
How often should a DNACPR order be reviewed? #WeLDNs
@samabdulla
23 February 2021 21:11
RT @WeLDnurses: How often should a DNACPR order be reviewed? #WeLDNs
@salsa442
23 February 2021 21:12
I think this is tricky to quantify, for me it’s Every time there is a significant change in someone’s clinical presentation, every hospital admission #WeLDNs https://twitter.com/WeLDnurses/status/1364321863262945289
@SueMarsden6
23 February 2021 21:12
@salsa442 @WeLDnurses It’s useful to tease these things out. Lots of people (of many backgrounds) think you can demand CPR. I’ve seen it in care plans “I wish to be resuscitated”. We need to get the balance right. #WeLDNs
@LuBrenda3
23 February 2021 21:13
@WeLDnurses Often it'll be great to prevent those incidents #weLDNs
@LDNurse_CH
23 February 2021 21:13
RT @WeNurses: Really interesting #WeLDNs just starting >
@salsa442
23 February 2021 21:14
@SueMarsden6 @WeLDnurses Yes I’ve been a part of some difficult conversations where the person wants to be resuscitated when clinically it would never be successful. There’s a very tricky balance for some #WeLDNs
@WeLDnurses
23 February 2021 21:14
It sounds like balance and clarity are key #WeLDNs https://twitter.com/suemarsden6/status/1364322350947307522
@samabdulla
23 February 2021 21:14
@salsa442 I struggled to word this, your right, clinical change, but also more regularly if the discussion is needed #weldns
@WeLDnurses
23 February 2021 21:15
What role can a learning disability nurse play within the process of applying or reviewing a DNACPR order? #WeLDNs
@SueMarsden6
23 February 2021 21:16
@WeLDnurses Yes totally agree. Sometimes rephrasing the question is helpful too, “what you want us to do if we found you’d quietly died in your sleep, and were very peaceful?” To answer this, and make own decisions regarding CPR I think quite a lot of understanding is required #WeLDNs
@salsa442
23 February 2021 21:16
@samabdulla For me it has to be clinically led as the DNACPR/ReSPECT is completely dependent on clinical need and presentation. Maybe if there is no change and person is stable then review during annual health check as a minimum? #WeLDNs
@salsa442
23 February 2021 21:17
#WeLDNs can be part of the best interest process, and review during health checks/audits etc https://twitter.com/weldnurses/status/1364322978222247943
@samabdulla
23 February 2021 21:18
@salsa442 I suppose I was thinking more about of the family/person wants to talk, we need to be available for that #weldns
@florenceella
23 February 2021 21:18
@SueMarsden6 @WeLDnurses I had a really interesting conversation with a hospice nurse earlier, she explained that she tries to take the emphasis off the lack of CPR and instead talk about what can be done to promote comfort and relieve pain #WeLDNs
@steve_grimbleby
23 February 2021 21:18
@WeLDnurses They can request for it to be reviewed and be involved in the review #WeLDNs ?
@SueMarsden6
23 February 2021 21:19
By starting conversations early on, and helping build a persons knowledge of their condition (ie physical comorbidities) esp if deteriorating picture. By challenging too when it’s not done right. #WeLDNs https://twitter.com/weldnurses/status/1364322978222247943
@WeLDnurses
23 February 2021 21:19
As nurses we definitely need to offer support to the individual and their family/ carers #WeLDNs https://twitter.com/samabdulla/status/1364323757385474052
@salsa442
23 February 2021 21:20
@samabdulla Ah yes, although in my experience if you do it right first time there’s opportunities for family/carers to ask those questions and have the discussion they need - less so during Covid though so important to consider this #WeLDNs
@WeLDnurses
23 February 2021 21:20
RT @steve_grimbleby: @WeLDnurses They can request for it to be reviewed and be involved in the review #WeLDNs ?
@nursingld
23 February 2021 21:20
@WeLDnurses Definitely when there’s a change in a persons health. If somebody is terminal then it’s unlikely to be needed but a minimum of annually #weldns
@drliberty
23 February 2021 21:20
@WeLDnurses #weldns advocacy, can help assist in assessing quality of life, input into annual health checks and reviews
@WeLDnurses
23 February 2021 21:21
Following on from that, what needs to change or happen moving forward? #WeLDNs
@WeLDnurses
23 February 2021 21:21
RT @drliberty: @WeLDnurses #weldns advocacy, can help assist in assessing quality of life, input into annual health checks and reviews
@WeLDnurses
23 February 2021 21:21
A theme that has come up a lot is ensuring that the individuals voice is heard #WeLDNs https://twitter.com/drliberty/status/1364324400456171522
@salsa442
23 February 2021 21:23
For me it’s the continued audit of all ReSPECT forms (done regularly where I am) and if you are working with someone you have a duty to know their DNACPR status, and challenge any poor terminology and/or poor practice relating to it #WeLDNs https://twitter.com/WeLDnurses/status/1364324436258742275
@LuBrenda3
23 February 2021 21:23
@WeLDnurses Equality and balance also we all don't know what's good for everyone it's better to promote and educates more about DNACPR to (family and carers /N from different backgrounds, religious and cultural) #weLDNs
@WeLDnurses
23 February 2021 21:23
This sounds like great practice #WeLDNs https://twitter.com/salsa442/status/1364324963767959552
@steve_grimbleby
23 February 2021 21:23
@WeLDnurses Learning Disabilities should not be the only reason for DNACPR All decisions related to DNACPR should be informed discussions #WeLDNs
@SueMarsden6
23 February 2021 21:24
#WeLDNs i think there needs to be better understanding on both sides. Medics need to understand more about the amazing q.o.l and resilience of some of the people we support, and of the support available, and they need to do DNACPRs properly! https://twitter.com/WeLDnurses/status/1364324436258742275
@steve_grimbleby
23 February 2021 21:24
RT @WeLDnurses: This sounds like great practice #WeLDNs
@samabdulla
23 February 2021 21:25
@WeLDnurses I would like to see these discussions embedded more in undergraduate programmes #weldns
@steve_grimbleby
23 February 2021 21:25
RT @SueMarsden6: #WeLDNs i think there needs to be better understanding on both sides. Medics need to understand more about the amazing q.o…
@salsa442
23 February 2021 21:25
RT @SueMarsden6: #WeLDNs i think there needs to be better understanding on both sides. Medics need to understand more about the amazing q.o…
@WeLDnurses
23 February 2021 21:25
RT @SueMarsden6: #WeLDNs i think there needs to be better understanding on both sides. Medics need to understand more about the amazing q.o…
@WeLDnurses
23 February 2021 21:25
This is a great idea, is this something that’s covered at the moment? #WeLDNs https://twitter.com/samabdulla/status/1364325417700761602
@SueMarsden6
23 February 2021 21:26
#WeLDNs but I also think we need to understand more about ordinary dying and ask those challenging questions https://twitter.com/WeLDnurses/status/1364324436258742275
@WeLDnurses
23 February 2021 21:26
#WeLDNs https://twitter.com/amysmith_5/status/1364325592116690949
@WeLDnurses
23 February 2021 21:26
RT @SueMarsden6: #WeLDNs but I also think we need to understand more about ordinary dying and ask those challenging questions
@steve_grimbleby
23 February 2021 21:26
RT @WeLDnurses: This is a great idea, is this something that’s covered at the moment? #WeLDNs
@WeLDnurses
23 February 2021 21:27
Well that hour has flown by! As we reach the end of the chat, what will you take away from tonight? #WeLDNs
@drliberty
23 February 2021 21:27
@WeLDnurses #weldns need more LD nurses in mainstream hospitals and continue to assist PwLD voices to be heard as genuine equal members of society. Need to spread the word louder outside of the LD world.......
@AmySmith_5
23 February 2021 21:27
@WeLDnurses Here was me thinking I was good for remembering the hashtag ?? #WeLDNs
@steve_grimbleby
23 February 2021 21:27
RT @WeLDnurses: #WeLDNs
@steve_grimbleby
23 February 2021 21:28
@WeLDnurses Some of the great processes already in place #WeLDNs
@SueMarsden6
23 February 2021 21:28
@chris_dlamini we are ahead of the game! #WeLDNs https://twitter.com/samabdulla/status/1364325417700761602
@salsa442
23 February 2021 21:28
It was the fastest hour! I’m going to keep reviewing ReSPECT forms, continue to challenge decisions that feel discriminatory, continue to be a part of the process and work in a balanced and ethical way to support good decision making #WeLDNs https://twitter.com/WeLDnurses/status/1364325918135697410
@WeLDnurses
23 February 2021 21:28
@SueMarsden6 @chris_dlamini This is great news! #WeLDNs
@AmySmith_5
23 February 2021 21:28
@steve_grimbleby @WeLDnurses LD should NEVER be any reason for DNACPR. #WeLDNs
@samabdulla
23 February 2021 21:29
@SueMarsden6 @chris_dlamini Hahah we talk about it here also but on reflection it warrants so much more. #weldns
@WeLDnurses
23 February 2021 21:29
RT @AmySmith_5: @steve_grimbleby @WeLDnurses LD should NEVER be any reason for DNACPR. #WeLDNs
@steve_grimbleby
23 February 2021 21:29
Thanks @WeLDnurses #WeLDNs and everyone involved for a great chat ??
@steve_grimbleby
23 February 2021 21:29
RT @AmySmith_5: @steve_grimbleby @WeLDnurses LD should NEVER be any reason for DNACPR. #WeLDNs




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