On entering hospital it is now standard practice for the admitting clinical team to discuss with you what treatment you want if you become critically ill. This information is recorded on a document called a Treatment Escalation Plan (TEP) form. This focuses on which treatments may or may not be most helpful for you. A variety of treatments can be considered, such as antibiotics, artificial feeding or ventilation of your lungs. The option of whether it would be helpful or not to readmit you to hospital in the future for further treatments may also be included in your plan.
The most important part of this discussion is what happens if your heart stops beating. This will happen to all of us at some point in our lives and for the vast majority it will be the moment of our death. The TEP form looks at the important issue of cardiopulmonary resuscitation, also known as CPR. This is the medical treatment that can be used to try to restart the heart and lungs if they suddenly stop working. It includes chest compressions and the use of a defibrillator to shock the heart back into beating. While resuscitation can be successful for some people, for others it is very unlikely to work. CPR can be very traumatic and it is not a suitable treatment for everybody. The older you are the less likely that you will recover your previous level of mental and physical function. The TEP form can be used to document the resuscitation decision that is right for your individual circumstances. If you decide that CPR would not be the right thing to do for you then the doctor will fill this in on the TEP form. It is called a do not attempt (try) to resuscitate or DNA CPR.
Until now this recording of a patient’s wishes was held on a piece of paper that could easily get misplaced. In the next few months these TEP forms will be available for all medical professionals to access on the Devon and Cornwall Care record. This is a new secure computer system that brings together information about your health and care and presents it as a single record. Healthcare staff can now see the details held by GP practices, hospitals and other health and care organisations across Devon, Cornwall and the Isles of ScillyHaving a more complete view of your medical history helps healthcare professionals identify problems more effectively and make quicker diagnoses. For instance, they can see which allergies you suffer from, any treatment and medication you have received plus quickly understand advance care decisions you have made using a TEP form.
You do not have to be in hospital to complete a TEP form. GPs are very happy to have this conversation with patients and complete the form together. It is actually more sensible to have the discussion when you are well rather than when you are sick and having to deal with the disorientating circumstances of being admitted to hospital.
We all understand the importance of writing a Will. Over the next few years, I think completing a TEP will be considered in a similar way. The fact that we can now record the information so it is easily accessed by hospital and ambulance teams means it can be reviewed and changed at any point with everyone knowing exactly what your wishes are.
Anthony O’Brien, Wyndham House Surgery