A patient on a secure ward at an Edinburgh hospital had an inappropriate do not attempt resuscitation form in their notes for the duration of the pandemic, according to a mental health watchdog.

Officers from the Mental Welfare Commission for Scotland said they “surprised and concerned” to find the directive in the notes of a patient in the secure forensic unit at the Royal Edinburgh Hospital.

The DNR, which was completed at the start of the pandemic and was still in place during the visit earlier this year, would “not have been appropriate”, the officers were informed. Ward staff were also unclear on why the document had been completed in the first place.

NHS Lothian’s Medical Director says staff acted quickly to remove the form after they were alerted to it, and a review has since taken place to check the records of other patients.

The Mental Welfare Commission visit to Redwood Ward, at the Royal Edinburgh Hospital’s Orchard Clinic, took place on 12 April and was published this week.

The clinic is a 40-bed medium secure forensic unit, which provides assessment and treatment for patients across Scotland who are deemed to pose a risk to others as a result of mental disorders.

Speaking to some of the 13 patients on the Redwood ward, the Mental Welfare Commission said patients were positive about their care and the clinic had remained covid-19 free.

But they said that Scottish government guidelines should be followed whenever DNR directives were being considered, and in this case had not been.

The visit report stated: “We were surprised and concerned to find a DNA CPR form in one patient’s record, which had been completed at the start of the pandemic and was of ‘indefinite’ duration.

“The staff we spoke with were unable to provide further information on this DNA CPR directive. We raised this urgently with senior staff on the visit and were advised the matter would be discussed directly with the patient’s consultant.

“We were told that DNA CPR status would not have been appropriate for patients on the ward at the time of our visit and that all patient records would be screened to ensure no other forms were in existence.”

In a statement, Dr Tracey Gillies, Medical Director for NHS Lothian said staff acted quickly to remove the DNA CPR document:

“In line with national guidance, NHS Lothian prepared Anticipatory Care Plans for appropriate patients on the ward at the start of the pandemic to replace DNA CPR forms.

"This was an isolated case in which the old form was unable to be removed immediately from the patient record but was rectified as soon as possible later that day.” 

“We take patient care extremely seriously and have carried out an extensive review of other patient records to ensure it does not happen again.  We apologise for any concern this may have caused the patient and their family.” 

This was one of a string of visit reports published by the Mental Welfare Commission

Visiting an intensive psychiatric care unit at the Royal Edinburgh, the watchdog expressed concerns about the ‘occasional’ admission of patients who do not require an IPCU bed simply because of bed shortages elsewhere.  

Meanwhile, MWC officers made no recommendations for improvement following a positive visits to a dementia ward at Ayr hospital and a psychiatric unit at Woodland view mental health hospital in Irvine.

Another report, on Gartnavel Royal Hospital’s intensive psychiatric care unit, produced no concerns, while a visit to a mental health ward at the hospital highlighted gaps in record-keeping.

An inspection at an Inverclyde Royal Hospital ward said more needed to be done to ensure medication prescription guidance was being followed.

Read more: Call for NHS Scotland DNACPR investigation; Watchdog finds DNRs kept secret from families; Clearer DNR advice pledged after virus controversy

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