Saskatoon Health Region implemented a revised resuscitation policy this spring, and both the policy and its promotion have been receiving praise from patients, families and staff.

The revised policy focuses on respect for autonomy by taking into consideration a patient’s culture, language, goals, values, and religious beliefs and practice. It allows for a multidisciplinary approach involving patients and their families together with medicine, nursing, social work, spiritual care (including elders), First Nations and Métis Health Service, and grief counseling services, so that psychosocial, cultural and spiritual care remain important aspects of health decision-making and care.

RR-2016-01-13-resus-brochure“We also made changes to the process, including specific next steps for resolution of contested decisions, and require a continuum of care where copies of the resuscitation plans travel with patients and residents,” explained Dr. Qaiser Fahim, ethicist, Saskatoon Health Region.

One of the strengths of the policy is that it helps mitigate the power differences between the care provider and receiver to uphold respect for autonomy and procedural justice in the decision making process, especially where a resuscitation decision is contested. This allows for equal opportunity to patients to access the type of care that is right for them across the Region.

Dr. Heather Ward and her team did initial research work which was very instrumental in guiding the development of the policy.

“Our resuscitation policy project is an example of a timely partnership with different people having similar interests and goals,” said Dr. Fahim. The policy changes were made following an in-depth eight month consultation process. The feedback from the consultations allowed for meaningful adjustments to the policy. Once the policy was rolled out, education was provided for Region staff, and has been ongoing for the past few months.

A brochure to accompany the policy was created by the Ethics Department of Saskatoon Health Region with the help of Dr. Jennifer Kryworuchko, a health services researcher at the University of British Columbia (formerly at the University of Saskatchewan). This brochure explains what causes the heart or breathing to stop, defining Cardiopulmonary Resuscitation (CPR), explaining when CPR can be used, how well CPR works and its side effects, what care can be provided when you do not want CPR, and how your wishes will be honoured.

The brochure is linked to information in a CPR teaching video, called “A decision aid to prepare patients and their families for shared decision-making about Cardio-Pulmonary Resuscitation (CPR)”.  The video was developed by Dr. Jennifer Kryworuchko and a group of researchers at the Canadian Researchers at the End of Life Network (CARENET). Using evidence about outcomes of CPR and their knowledge of the shared decision-making process, they developed a plain language script for the video, which was produced by Doug Nicolle at Providence Health Care.

The video was reviewed by experts and community members and has been tested with patients with advanced illness and to their family members. One of the places it was tested was in Saskatoon at St. Paul’s Hospital.  The video was designed to prepare people have better conversations together.

Dr. Kryworuchko indicated that there’s a range of quality of conversations that health care professionals have with their patients – from a really abbreviated “what do you want?” to really full conversations that focus on people’s values and goals regarding resuscitation and how it fits into their greater plan. The brochure is linked to the video to help staff initiate these more challenging and fuller conversations.

Making the conversation about resuscitation more routine makes it easier for people to have the conversation, Dr. Fahim believes.

A concern among health professionals was that families and patients are not informed and they don’t seem to understand information.

“The health care team struggles sometimes with giving people plain language and core information about what it means to be resuscitated, what the outcomes are and what this process is,” Dr. Kryworuchko said. “Many people are able to use this video as a tool to initiate conversation with their health care provider and to help ask questions that they have about resuscitation. It bridges the gap between the patient and the provider.”

Both brochure and video were rolled out across the Region last fall.

“We have received an overwhelming feedback from staff and patients about the brochure and video”, reports Dr. Fahim. He has heard from patients, family members and from managers on the wards, and all found the video and brochure very easy to understand and helpful with their decision making.

Physicians have also commented that the brochure and video are very helpful in initiating the discussion between their clients.

“Patients and families have said they would like to see this video running somewhere on a screen so that there is regular and easy access to it,” said Dr. Fahim. “The challenge is that not everyone has access to a computer in their departments or the resources. Some departments are providing a family booklet to patients and their families, which includes our resuscitation brochure. This brochure and video have been a real value to the patient and to the health care team.”