Using an Acute Resuscitation Plan
Patients who should have an ARP
An ARP form should be completed where it is reasonably expected than an adult patient (18 years and over) may suffer an acute deterioration or critical event (for example, a cardiac or respiratory arrest) in the foreseeable future and require resuscitation planning.
Queensland Health guidelines suggest that a medical officer should consider completing an ARP form for adult patients who have conditions such as:
- metastatic cancer
- deterioration of a chronic respiratory, cardiac, liver or neurological illness
- end-stage dementia
- renal failure
- severe trauma
- serious neurological events
- recurrent hospital admissions with a severe chronic illness.
Completing an ARP
The most senior medical officer available should complete and sign an ARP form.
There is no legal requirement for the patient or substitute decision-maker(s) to sign the ARP form because:
- consent in Queensland can be verbal
- it is not formally witnessed
- it is not a legal document like an advance health directive.
If there is no senior medical officer, such as in facilities in very remote areas, a more junior doctor or other health professional may complete and sign the ARP form under the authorisation of a senior medical officer (for example, over the phone or by email).
If a patient is admitted to a Queensland Health residential aged care facility, the general practitioner (GP) who visits the patient may complete an ARP form for them, if this is appropriate. Queensland Health staff can act on its instructions, provided the instructions are clear, but note an ARP form is not ‘consent’ and should not be relied upon in the absence of appropriate consent.
A GP is not responsible for completing an ARP form for a patient in their private clinic or surgery because the ARP form is completed in a hospital or residential aged care setting. It may be appropriate for a GP to receive a copy of an ARP form that has been completed at a hospital. This can be noted in Section 6 of the ARP form.
Filing and review of ARPs
Completed ARP forms are filed at the front of the patient's medical record. There should only be one "active" ARP form at any one time.
An ARP form should be reviewed from time to time, depending on:
- recommendations provided by the medical officer who completed the form
- changes to the patient's clinical or personal circumstances.
A new ARP form should be initiated in these circumstances, and the earlier ARP form voided.
The ARP form is voided by:
- drawing two diagonal lines across the front and back pages
- writing "VOID" between the lines
- signing and dating the notation
- filing the voided ARP form at the back of the patient's medical record to avoid any confusion between versions.
Patients can see or ask about what is written on their ARP form through the Right to Information request process.
Transferring a patient with an ARP form
If a patient is transferred to another facility, the original ARP form must remain on their medical record at the original facility. The discharging medical officer may determine that it is appropriate for a copy of the patient's ARP form to accompany them and other medical records to the facility to which they are being transferred.
If the receiving facility is a Queensland Health facility (such as a hospital or residential aged care facility), the receiving healthcare team should:
- consider the information contained on the copy of the ARP form
- if appropriate a medical officer should complete a new ARP form for use at that facility.
If the patient has a cardiac or respiratory arrest and there has been insufficient time to complete a new ARP form, the receiving healthcare team should use their clinical judgement at the time to determine whether to follow the instructions on the copy of the ARP form, and take appropriate action.
If the receiving facility is not a Queensland Health facility (such as a private hospital or private residential aged care facility), the information contained on the copy of the ARP form is provided for information only. The receiving facility must determine their own resuscitation planning practices and procedures.