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Please identify which tier of training you need to access using the grid and scroll down to reach the appropriate tier.

  Consultants, Registrars and GPs Doctors in Training and Non-consultant career grade doctors Core medical trainees (CMTs), Foundation Year (FY1/ FY2) Senior and specialist nurses and AHPs who would like/ need to be able to implement the process Paramedics, clinical hub and Out of Hours practitioners Nurses, AHPs and other registered healthcare professionals Care Home Managers/ Non-registered care assistants and support workers. Adult social care., Social prescribers, Care coordinators Non-clinical and administrative staff incl emergency service call handlers Members of the public, patients and their carers, Charities, Police, Fire Service, Education establishments
ReSPECT Tier 1 — Awareness (What is ReSPECT?)
For all staff working with patients (clinical and non-clinical), members of the public, carers and volunteers 		YES YES YES YES YES YES YES YES YES
ReSPECT Tier 2 —Starting the conversation and caring for someone with a ReSPECT plan)
For clinical staff (including non-registered staff) working in care homes, ambulance services, acute Trusts, out-of-hours and community providers who will need to recognise the plan and act on the recommendations. 		YES YES YES YES YES YES YES    
ReSPECT Tier 3 — Discussing and recording clinical recommendations
For clinical staff (Registered Practitioners including nurses, AHP, and Doctors) who will undertake the process with patients, and for staff interested in supporting.
( Could support/ buddying/ confidence and competence/proficiency in practice)

  • incorporating into business-as-usual training (e.g., updates, simulations, and ongoing role essential training)**
 YES YES YES YES YES YES      

All the required information and resources are linked within each tier.

RESPECT grid

Learning Objectives

To understand what ReSPECT is and the benefits of having a plan. Recommended Summary Plan for Emergency Care and TreatmentThe ReSPECT process creates personalised recommendations for a person’s clinical care and treatment in a future emergency in which they are unable to make or express choices.

These recommendations are created through conversations between a person, their families, and their health and care professionals to understand what matters to them and what is realistic in terms of their care and treatment.

Patient preferences and clinical recommendations are discussed and recorded on a non-legally binding plan which can be reviewed and adapted if circumstances change.
To understand who a ReSPECT plan is for. Anyone can have a ReSPECT plan. It is however more likely to include:

  • complex health needs,
  • people who are likely to be nearing the end of their lives,
  • people who are at risk of sudden deterioration or cardiac arrest.

Some people will want to record their care and treatment preferences for other reasons.
Be aware of the ReSPECT plan paperwork and sections included.
To understand the process involved for a ReSPECT plan to be completed. A ReSPECT plan completion can take place over several conversations with different people including the person and their family/carers.
To understand where a ReSPECT plan should be stored and link with WMTM folder in Gloucestershire.(Agree consistent message about storage in fridge (lions bottle) or stick to fridge, and ensure family/carers know where plan is kept). The learner will understand that the ReSPECT Form needs to be easily accessible at all times, depending on setting in the front of clinical notes; clearly defined section of notes; or easily accessible in the home settingThe learner will know how to access onto electronic systems as appropriate.
To be able to access appropriate supporting information about ReSPECT.

Essential resources for Tier 1:

Learning Objectives

Basic awareness as Tier 1
Identify who could be offered a ReSPECT conversation Anyone can have a ReSPECT conversation. It is however more likely to include:

  • complex health needs,
  • people who are likely to be nearing the end of their lives,
  • people who are at risk of sudden deterioration or cardiac arrest.

Some people will want to record their care and treatment preferences for other reasons.
Identify who can record the conversation relating to values and fears (Sections 1-3)
Identify areas an initial ReSPECT conversation should cover Sections 1-3
Identify good practice in plan completion Useful information to include and examples of useful phrases.
Identify ReSPECT plans where more information would be beneficial to support the patient’s values, and know how to escalate concerns Identify examples of poor plans
To identify when a ReSPECT plan and therefore conversation needs review Understand the circumstances when a ReSPECT conversation needs revisiting (this may not result in a new plan if only minimal changes are required):

  1. Change of setting
  2. Change of condition
  3. Change of wishes or choices

To understand there is no expiry or review date routinely for ReSPECT, other than the circumstances listed above.
How to care for a person with a ReSPECT conversation and plan in place – Ask and Check Understand Ask and Check and understand who to escalate to if a review is required.
ReSPECT reasonable adjustments Understand the resources that are available to support people requiring reasonable adjustments to have a ReSPECT conversation and plan.
Mental Capacity Training as required for role

Essential resources for Tier 2:

  • Tier 1 resources (as applicable to increase knowledge related to role).
  • Watch the video “ReSPECT conversations – An update for healthcare professionals”. ReSPECT Conversations – An update for healthcare professionals
  • Watch the Tier 2 session recording. (link)
  • Discuss ReSPECT with your team – Understand the local processes for supporting ReSPECT within your team and how your role can complement this important work.

Learning Objectives

Learning Objectives completed for Tier 1
Learning Objectives completed for Tier 2
To understand the differences between the ReSPECT conversation/process and that of CPR/DNACPR

ReSPECT is not just a replacement DNACPR form.ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. The ReSPECT process creates a summary of personalised recommendations for a person’s clinical care in a future emergency in which they do not have capacity to make or express choices.

The process is intended to respect both patient preferences and clinical judgement. The agreed realistic clinical recommendations that are recorded include a recommendation on whether or not CPR should be attempted if the person’s heart and breathing stop.
To understand what needs to be considered before the ReSPECT conversation takes place

People: The learner understands who should lead the conversation, who they are having the conversation with and who else could/ should be there. Consider if this person has mental capacity to take part in the ReSPECT discussion.Timing: The learner understands the best time to have the conversation; ideally in a non-urgent situation and optimum time for that person.

Setting: The learner understands the need for quiet and privacy where possible; time to talk without interuptions if possible.

Information Gathering: The learner understands the need to gather PMH, seek consensus about approriate interventions; what information has already been given; cultural considerations e.g., interpreter; accomodating for those with hearing or visual impairments and poor functional literacy;
How to effectively hold and record the ReSPECT conversation The learner will be able to explain the purpose of the conversation and understand the need to involve the person in the ReSPECT conversation.

  • The learner will consider if the person has/ has not capacity and act in accordance with the MCA 2005.
  • The learner will be able to initiate conversations to enable the flow for the ReSPECT concversation and recording it.
  • The learner will provide time and seek feedback during the conversation to ensure understanding and comprehension.
  • The learner will understand the need to record clearly and unambiguiously in persons own words avoiding abbreviations.
  • The learner will be able to observe and be observed whilst holding their initial ReSPECT conversations.
  • The learner will have the opportunity to reflect, record and learn from their ReSPECT experiences.
  • The learner will have the opportunity to have feedback from their observer.
  • The learner will have access to a mentor or buddy if this is available.
Recording the conversation and recommendations Section 1: Personal details box fully completed
Section 2: Shared understanding of my health and current condition is discussed and explored and relevant detail recorded including location of other relevant documents.

Section 3: personal preferences are recorded if the person has capacity to get an understanding of goals of care and treatment

Opportunity to express values and fears

Section 4: is clearly documented and signed appropriately

Clinical guidance is recorded in clear recommendations about the types of care or realistic treatment to achieve goals followed by things which they wouldn’t want or would not work in their own individual situation

Record CPR/DNACPR and sign one box only. If CPR would not work and is not being offered, refer to the agreed goals of care (Section 3) and explain why
Section 5: To understand the importance of documenting if this person has capacity (knowledge of MCA 2005) for involvement in their ReSPECT plan and if not who else is involved/ Best Interest decision making

Section 6: who has been involved in making the plan

Confirm the process and plan has been completed in accordnace with capacity and human rights

Understand that if section D has been ticked then valid reasons must be stated and recorded in the clinical record

Section 7: Clinicians Signatures: that the registered practitioners must add a legible signature together with registration number and date and sign. If they are not the Senior Responsible Clinician then they should be informed and agree to the plan

Refer to local organisational policy re timeframes
Section 8: Emergency contact details will be recorded so that they should be readily available in the event of an emergency. Details of those involved in making the plan should be recorded in case further contact is needed.
ReSPECT Reasonable Adjustments Ability to make reasonable adjustments for information provided to people and conversations held.The learner will understand how to record if a person doesn’t feel ready for the ReSPECT conversation
Mental Capacity Training as required for role

Essential resources for Tier 3:

  • Tier 1 resources (as applicable to increase knowledge related to role).
  • Tier 2 resources (as applicable to increase knowledge related to role).
  • Watch the Tier 3 session recording (1 hour). (link)
  • Attend a Community of Practice online session – these sessions will be led by a clinician experienced in the ReSPECT process and will allow the opportunity to discuss experiences and ask questions related to practice. (link)
  • One Gloucestershire ReSPECT podcast series (add link)