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J Med Ethics 36:518-520 doi:10.1136/jme.2009.033977
  • Clinical ethics

A patient and relative centred evaluation of treatment escalation plans: a replacement for the do-not-resuscitate process

  1. M Mercer
  1. Departments of Anaesthesia and Critical Care Medicine, and Orthopaedic Surgery, Torbay Hospital, Torquay, Devon, UK
  1. Correspondence to Lucy Obolensky, Derriford Hospital, Plymouth, The Great Hall, Combefishcare, Ipplepen, Devon TQ12 5UQ, UK; lucyobolensky{at}live.co.uk
  • Received 21 October 2009
  • Revised 15 April 2010
  • Accepted 4 May 2010

Abstract

The Treatment Escalation Plan (TEP) was introduced into our trust in an attempt to improve patient involvement and experience of their treatment in hospital and to embrace and clarify a wider remit of treatment options than the Do Not Resuscitate (DNR) order currently offers. Our experience suggests that the patient and family are rarely engaged in DNR discussions. This is acutely relevant considering that the Mental Capacity Act (MCA) now obliges these discussions to take place. The TEP is a form that the doctor completes, ideally with the competent patient or close relative, documenting what treatment options would be appropriate if that patient were to become acutely unwell. Ventilation of the lungs, cardiac resuscitation, renal replacement therapy, intravenous fluids and antibiotics are all discussed. The study evaluated patient and relative experiences with the TEP. 55 patients or their relatives were interviewed regarding their experience of the TEP and thoughts regarding the process. 96% of patients and relatives evaluated thought that the TEP was a good idea. Free text comments were all positive and only 34% of patients claimed to feel anxious when completing the form. Following this study, the TEP has been expanded hospital wide and into the community within our trust. Discussions are currently taking place in hospitals within our region to introduce the TEP form into other local trusts.

Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Received 21 October 2009
  • Revised 15 April 2010
  • Accepted 4 May 2010

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