Child 18 years and under recommended summary plan for emergency care and treatment procedure

1 Aim

Within Rotherham Doncaster and South Humber NHS Foundation Trust (the trust) physically ill children under 18 years of age will be under the care of a consultant from a neighbouring acute trust. However, these children may be cared for within the community by trust services.

The document used to document the resuscitation status of a child under the age of 18 years is the recommended summary plan for emergency care and treatment (ReSPECT) document. Please see the ReSPECT procedure for emergency care planning and do not attempt cardiopulmonary resuscitation (DNACPR) decisions that have used this process.

The clinical circumstances that surround cardiorespiratory arrest in children differ from those of adults; the legal and ethical aspects also differ.

It is vital that when these agreements have been made that the child is offered the same treatment by all clinicians involved in their care.

The aim of this procedure is to ensure that trust colleagues are aware of their responsibilities surrounding the children and young peoples advanced care planning (CYACP) which is the children’s ReSPECT form.

The procedure aims to ensure a consistent approach for sharing the planned decisions for children across the trust and to ensure that decisions that have been made about children in other specialist services can transfer between the different services and localities of the trust and that the trust does not compromise patient care.

The procedure outlines the duties and responsibilities of the trust to comply with relevant legislation and guidance.

1.1 Definitions

2 Scope

This procedure applies to all managers with responsibilities derived from it, and all clinical colleagues with direct patient contact, including bank, agency, and temporary contract colleagues.

3 Link to overarching policy

The procedure should be read as part of the resuscitation manual and the associated documents.

4 Procedure

If a child within the care of the trust children’s services has an existing recommended summary plan for emergency care and treatment (ReSPECT) from within another organisation, the lead trust clinician should liaise with the child’s consultant from the other organisation, the child and their family to discuss this and to ensure that circumstances have not changed and that is still current

4.1 Communication of the order

The lead trust clinician must ensure that all clinicians involved in the child’s care are aware of the order.

The order must remain with the child. Discussions should be held with the child if possible, and their parents as to the importance of ensuring the document goes with them when they are attending services, school etc.

Any child that has a child and young persons advance care plan (CYPACP) in place should have an alert added to SystmOne by the practitioner completing the recommended summary plan for emergency care and treatment (ReSPECT) trust template to alert multidisciplinary teams that the child or young person has a ReSPECT in place.

Also the clinician should add a reminder (high priority category) stating that ReSPECT in place and where the electronic version is saved in the patient record.

The key clinician should also notify South Yorkshire Ambulance Service (YAS) for an alert to be flagged on their systems.

If the decision within the ReSPECT is that in the case of cardiopulmonary arrest that resuscitation will not take place, this needs to be clearly documented and shared with relevant parties. In the event of this decision being made the lead trust clinician will inform the trust medical director and share the respect document with them.

4.2 Presumption to resuscitate

“All patients being attended by a clinician, whether in hospital, healthcare unit or their own home, are to be actively and vigorously resuscitated and suitable assistance called, unless they have a recommended summary plan for emergency care and treatment (ReSPECT) that details otherwise. Where no decision has been made about cardiopulmonary resuscitation (CPR) before any subsequent cardiopulmonary arrest, and the express wishes of the person are unknown it is expected that colleagues will attempt resuscitation.

However, the Resuscitation Council state the below, which does allow for some senior clinical decision-making.

“Where no explicit decision about CPR has been considered and recorded in advance there should be an initial presumption in favour of CPR. However, in some circumstances where there is no recorded explicit decision (for example a person in the advanced stages of a terminal illness where death is imminent and unavoidable, and CPR would not be successful) a carefully considered decision not to start inappropriate CPR should be supported.” (Resuscitation Council 2021)

Is it important to note that healthcare or nursing assistants must commence CPR if a ReSPECT form is not in place that details that resuscitation is not to be undertaken.

In circumstances where CPR has been initiated without the knowledge of an existing documented decision to not resuscitate, and this form is presented the continuation of CPR would be inappropriate however the decision to stop must come from a senior healthcare professional (doctor or registered nurse). If there is any doubt, CPR should continue until reviewed by the attending paramedic or doctor.

4.3 Review of the recommended summary plan for emergency care and treatment form

The recommended summary plan for emergency care and treatment (ReSPECT) form will be reviewed when the health needs or circumstances changes, although it Is good practice to review at least annually, and should be reviewed in each person’s individual situation.

Document control

• Version: 2.
• Date ratified: 13 May 2025.
• Ratified by: Clinical effectiveness group.
• Name of originator: Resuscitation officer and head of education.
• Name of responsible individual: Chief nursing officer.
• Date issued: 24 June 2025.
• Review date: 30 June 2028
• Target audience: All clinical staff working in all service areas including the community.
• Description of change:
  • change of title
  • addition of clarity around the use of the recommended summary plan for emergency care and treatment (ReSPECT) document
  • grammatical errors corrected
  • changed staff to colleague
  • removed repetition and unused words in definitions
  • removed reference to do not attempt cardiopulmonary resuscitation (DNACPR) and replaced with ReSPECT
  • added that need to record in patient record where the ReSPECT document is saved in records and that need to inform ambulance service of patients with a ReSPECT in place
  • removed letter appendix L and added in main body that if decision for not to resuscitate medical director to be informed

Page last reviewed: June 25, 2025
Next review due: June 25, 2026