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.
Ideally, ARP forms should be completed before the patient’s condition deteriorates and while they are still able to actively participate in decision-making about their future healthcare. ARP forms are not intended as something to leave ‘until the last moment’, when the patient suffers partial or complete loss of decisional capacity. Generally, adult patients of any age diagnosed with a life-limiting illness, and/or where deterioration in their condition is reasonably predictable, should have an ARP.
Completing an ARP
The most senior medical officer available should complete and sign an ARP form.
ARP forms should be completed after discussing resuscitation planning with the patient or the patient’s substitute decision-maker if the patient has impaired capacity.
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).
Non-Queensland Health facilities
ARPs are not mandated in private residential aged care facilities but may be used by GPs whose patients are likely to be admitted to Queensland Health facilities from time to time. Local procedures at private facilities will determine if, how and when ARP forms are completed and used. If the patient is admitted to a Queensland Health facility, it is good practice to review ARPs used in these circumstances.
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 directions, provided they are clear. It is important to note that an ARP form is not ‘consent’ and should not be relied upon in the absence of appropriate consent.
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. Non-Queensland Health receiving facilities must determine their own resuscitation planning practices and procedures.
For further information about initiating, completing and reviewing ARPs, refer to the End-of-life care: Guidelines for decision-making about withholding and withdrawing life-sustaining measures from adult patients.
Queensland Ambulance Service and ARPs
Queensland Ambulance Service (QAS) incorporates the ARP into their clinical practice guidelines. Local QAS procedures will determine how these clinical guidelines are applied. When it is known patients in transit to or from a Queensland Health facility have an ARP, attending paramedics can verify the directions by contacting the doctor nominated on 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.
The information provided on these pages is general in nature and is not intended as legal advice. Resuscitation planning issues will often be complex—you need to consider individual circumstances, and sometimes the level of detail will mean further advice is required. If you are in any doubt please seek legal advice.