ReSpect Care Plan Template

ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) is a process of creating a personalised plan of care for someone’s clinical needs in an emergency situations where they are not able to make decisions or express their own wishes.


Key objectives

To provide patients with a digital version of the ReSpect plan, giving healthcare professionals access to their wishes and making sure emergency teams know them at the point of care.


Outcome measures

Equip patients with the tools they need to document and share their wishes for treatment, to support difficult conversations and support self-management of complex health conditions, as well as providing the tools they need to interact digitally rather than relying on a face to face consultations.


Current Baselines

Paper base document that is accessible in emergency situations, meaning patients wishes are followed.

Workflow


  1. Patient: Record created and invited to register

  2. Patient: Claims their PKB record

  3. GP practice: Add carer to patient's record

  4. Carer: Claims their patient PKB record. Ability to view the relatives/friends record as a carer

  5. Patient: Attends appointment with GP

  6. GP: Views patients PKB record

  7. GP: Adds and completes care plan with patient wishes

  8. Carer/Patient: Ability to change care plan

  9. PKB: Displaces audit trail of any changes to the ReSpect care plan

  10. Patient/carer: Uses care plan to view wishes and share in emergency situations

  11. Emergency teams: Has the ability to view patients care plan

ReSpect Care Plan Template

Example care plan template code for ReSpect Care Plan HTML

<div class="form-inline">

<style media="screen">

.form-group {width: 100%; !important}

.cp_separator {height: 3px; background-color: #54496f;; margin-top: 5px; margin-bottom: 5px;}

.row-eq-height {display: -webkit-box;display: -webkit-flex;display: -ms-flexbox;display: flex; text-align: center;}

</style>

<div style="background-color:#bbb4d9; padding:15px;">

<h2>2. Summary of relevant information for this plan <a href="#section6">(see also section 6)</a></h2>

<div class="row">

<div class="col-sm-12">

<label for="cp_relevantInfo_1">Including diagnosis, communication needs (e.g. interpreter, communication aids) and reasons for the preferences and recommendations recorded.</label>

<textarea class="form-control" name="cp_relevantInfo_1" id="cp_relevantInfo_1" rows="3" style="width: 100%; border: 2px; border-style: solid; border-color: #897ab8;"></textarea>

</div>

</div>

<div class="row">

<div class="col-sm-12">

<label for="cp_relevantInfo_2">Details of other relevant planning documents and where to find them (e.g. Advance Decision to Refuse Treatment, Advance Care Plan). Also include known wishes about organ donation.</label>

<textarea class="form-control" name="cp_relevantInfo_2" id="cp_relevantInfo_2" rows="3" style="width: 100%; border: 2px; border-style: solid; border-color: #897ab8;"></textarea>

</div>

</div>

<h2>3. Personal preferences to guide this plan (when the person has capacity)</h2>

<div class="row">

<div class="col-sm-12">

<div class="form-check">

<input class="form-check-input" type="radio" name="cp_preference" id="inlineRadio1" value="0 - Prioritise sustaining life, even at the expense of some comfort"> 0 - Prioritise sustaining life, even at the expense of some comfort</input>

</div>

<div class="form-check">

<input class="form-check-input" type="radio" name="cp_preference" id="inlineRadio1" value="1"> 1</input>

</div>

<div class="form-check">

<input class="form-check-input" type="radio" name="cp_preference" id="inlineRadio1" value="2"> 2</input>

</div>

<div class="form-check">

<input class="form-check-input" type="radio" name="cp_preference" id="inlineRadio1" value="3"> 3</input>

</div>

<div class="form-check">

<input class="form-check-input" type="radio" name="cp_preference" id="inlineRadio1" value="4"> 4</input>

</div>

<div class="form-check">

<input class="form-check-input" type="radio" name="cp_preference" id="inlineRadio1" value="5"> 5</input>

</div>

<div class="form-check">

<input class="form-check-input" type="radio" name="cp_preference" id="inlineRadio1" value="6"> 6</input>

</div>

<div class="form-check">

<input class="form-check-input" type="radio" name="cp_preference" id="inlineRadio1" value="7"> 7</input>

</div>

<div class="form-check">

<input class="form-check-input" type="radio" name="cp_preference" id="inlineRadio1" value="8"> 8</input>

</div>

<div class="form-check">

<input class="form-check-input" type="radio" name="cp_preference" id="inlineRadio1" value="9"> 9</input>

</div>

<div class="form-check">

<input class="form-check-input" type="radio" name="cp_preference" id="inlineRadio1" value="10 - Prioritise comfort, even at the expense of sustaining life"> 10 - Prioritise comfort, even at the expense of sustaining life</input>

</div>

</div>

</div>

<div class="row">

<div class="col-sm-12">

<label for="cp_mostImportant"><h3>Considering the above priorities, what is most important to you is (optional):</h3></label>

<textarea class="form-control" name="cp_mostImportant" id="cp_mostImportant" rows="3" style="width: 100%; border: 2px; border-style: solid; border-color: #897ab8;"></textarea>

</div>

</div>

</div>

<div style="background-color:#897ab8; padding:15px;">

<h2 style="color: #ffffff;">4. Clinical recommendations for emergency care and treatment</h2>

<div class="row">

<div class="col-sm-6">

<label for="cp_focusLifeSustaining"><h3>Focus on life-sustaining treatment as per guidance below</h3></label>

<textarea class="form-control" name="cp_focusLifeSustaining" id="cp_focusLifeSustaining" rows="3" style="width: 100%;"></textarea>

</div>

<div class="col-sm-6">

<label for="cp_focusSymptomControl"><h3>Focus on symptom control as per guidance below</h3></label>

<textarea class="form-control" name="cp_focusSymptomControl" id="cp_focusSymptomControl" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row">

<div class="col-sm-12">

<label for="cp_clinicalGuidence"><h3>Now provide clinical guidance on specific interventions that may or may not be wanted or clinically appropriate, including being taken or admitted to hospital +/- receiving life support:</h3></label>

<textarea class="form-control" name="cp_clinicalGuidence" id="cp_clinicalGuidence" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row row-eq-height" style="padding-top: 20px;">

<div class="col-sm-4" style="background-color: #ffffff;">

<label for="cp_cprAttemptsRecomended"><h3>CPR attempts recommended Adult or child</h3></label>

<input type="text" name="cp_cprAttemptsRecomended" id="cp_cprAttemptsRecomended" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-4" style="border: 2px; border-style: solid; border-color: #ffffff;">

<label for="cp_modifiedCPRChild" style="background-color: #897ab8"><h3 style="color:#ffffff">For modified CPR <b>Child only, as detailed above</b></h3></label>

<input type="text" name="cp_modifiedCPRChild" id="cp_modifiedCPRChild" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-4" style="border: 2px; border-style: solid; border-color: red;background-color: #ffffff;">

<label for="cp_cprAttemptsRecomended2"><h3>CPR attempts <b>NOT</b> recommended Adult or child</h3></label>

<input type="text" name="cp_cprAttemptsRecomended2" id="cp_cprAttemptsRecomended2" class="form-control" style="width: 100%;"></input>

</div>

</div>

<h2 style="color: #ffffff;">5. Capacity and representation at time of completion</h2>

<div class="row" style="background-color:#ffffff; border: 2px; border-style: solid; border-color: #54496f;">

<div class="col-sm-8">

<label for="cp_sufficentCapacity"><h3>Does the person have sufficient capacity to participate in making the recommendations on this plan?</h3></label>

</div>

<div class="col-sm-4">

<div class="radio" style="margin-left: 15px;">

<div class="form-check">

<input class="form-check-input" type="radio" name="cp_sufficentCapacity" id="cp_sufficentCapacityYes" value="Yes" style="padding-left: 15px;"> Yes</input>

</div>

<div class="form-check">

<input class="form-check-input" type="radio" name="cp_sufficentCapacity" id="cp_sufficentCapacityNo" value="No" style="padding-left: 15px;"> No</input>

</div>

</div>

</div>

</div>

<div class="row" style="background-color:#ffffff; border: 2px; border-style: solid; border-color: #54496f; margin-top: 5px;">

<div class="col-sm-8">

<label for="cp_sufficentCapacity"><h3>Do they have a legal proxy (e.g. welfare attorney, person with parental responsibility) who can participate on their behalf in making the recommendations? If so, document details in emergency contact section below</h3></label>

</div>

<div class="col-sm-4">

<div class="radio" style="margin-left: 15px;">

<div class="form-check">

<input class="form-check-input" type="radio" name="cp_sufficentCapacity" id="cp_sufficentCapacityYes" value="Yes" style="padding-left: 15px;"> Yes</input>

</div>

<div class="form-check">

<input class="form-check-input" type="radio" name="cp_sufficentCapacity" id="cp_sufficentCapacityNo" value="No" style="padding-left: 15px;"> No</input>

</div>

<div class="form-check">

<input class="form-check-input" type="radio" name="cp_sufficentCapacity" id="cp_sufficentCapacityYes" value="Unknown" style="padding-left: 15px;"> Unknown</input>

</div>

</div>

</div>

</div>

<h2 style="color: #ffffff;" id="section6">6. Involvement in making this plan</h2>

<div class="row" style="background-color:#ffffff; border: 2px; border-style: solid; border-color: #54496f; padding: 15px; margin-bottom: 5px;">

<h3>The clinician(s) signing this plan is/are confirming that (select A,B or C, OR complete section D below):</h3>

<div class="row">

<div class="form-check" style="padding: 15px;">

<input class="form-check-input" type="checkbox" value="A This person has the mental capacity to participate in making these recommendations. They have been fully involved in making this plan." id="cp_6a" name="cp_6a"> A This person has the mental capacity to participate in making these recommendations. They have been fully involved in making this plan.</input>

</div>

</div>

<div class="row">

<div class="form-check" style="padding: 15px;">

<input class="form-check-input" type="checkbox" value="B This person does not have the mental capacity to participate in making these recommendations. This plan has been made in accordance with capacity law, including, where applicable, in consultation with their legal proxy, or where no proxy, with relevant family members/friends." id="cp_6b" name="cp_6b"> B This person does not have the mental capacity to participate in making these recommendations. This plan has been made in accordance with capacity law, including, where applicable, in consultation with their legal proxy, or where no proxy, with relevant family members/friends.</input>

</div>

</div>

<div class="row" style="background-color: #e3dfef;">

<div class="form-check" style="padding: 15px;">

<input class="form-check-input" type="checkbox" value="C This person is less than 18 (UK except Scotland) / 16 (Scotland) years old and (please select 1 or 2, and also 3 as applicable or explain in section D below):" id="cp_6c" name="cp_6c"> C This person is less than 18 (UK except Scotland) / 16 (Scotland) years old and (please select 1 or 2, and also 3 as applicable or explain in section D below):</input>

</div>

</div>

<div class="row" style="background-color: #e3dfef;">

<div class="form-check" style="padding: 15px;">

<input class="form-check-input" type="checkbox" style="margin-left: 15px;" value="1 They have sufficient maturity and understanding to participate in making this plan" id="cp_61" name="cp_61"> 1 They have sufficient maturity and understanding to participate in making this plan</input>

</div>

</div>

<div class="row" style="background-color: #e3dfef;">

<div class="form-check" style="padding: 15px;">

<input class="form-check-input" type="checkbox" style="margin-left: 15px;" value="2 They do not have sufficient maturity and understanding to participate in this plan. Their views, when known, have been taken into account." id="cp_6c2" name="cp_6c2"> 2 They do not have sufficient maturity and understanding to participate in this plan. Their views, when known, have been taken into account.</input>

</div>

</div>

<div class="row" style="background-color: #e3dfef;">

<div class="form-check" style="padding: 15px;">

<input class="form-check-input" type="checkbox" style="margin-left: 15px;" value="3 Those holding parental responsibility have been fully involved in discussing and making this plan." id="cp_6c3" name="cp_6c3"> 3 Those holding parental responsibility have been fully involved in discussing and making this plan.</input>

</div>

</div>

<div class="row">

<div class="col-sm-12">

<label for="cp_6d">D If no other option has been selected, valid reasons must be stated here. Document full explanation in the clinical record.</label>

<textarea class="form-control" name="cp_6d" id="cp_6d" rows="3" style="width: 100%;"></textarea>

</div>

</div>

</div>

<div class="row" style="background-color:#ffffff; border: 2px; border-style: solid; border-color: #54496f; padding: 15px;">

<div class="row">

<div class="col-sm-12">

<label for="cp_rolesDiscussions"><h3>Record date, names and roles of those involved in decision making, and where records of discussions can be found:</h3></label>

<textarea class="form-control" name="cp_rolesDiscussions" id="cp_rolesDiscussions" rows="3" style="width: 100%;"></textarea>

</div>

</div>

</div>

<h2 style="color: #ffffff;">7. Clinicians' signatures</h2>

<div class="row" style="background-color:#ffffff; border: 2px; border-style: solid; border-color: #54496f; padding: 15px;">

<div class="row hidden-xs">

<div class="col-sm-3">

<h3>Designation (grade/speciality)</h3>

</div>

<div class="col-sm-3">

<h3>Clinician name </h3>

</div>

<div class="col-sm-3">

<h3>GMC/NMC/HCPC Number</h3>

</div>

<div class="col-sm-3">

<h3>Date &#38; time</h3>

</div>

</div>

<div class="row">

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Designation (grade/speciality)</h3>

<input type="text" name="cp_designation_1" id="cp_designation_1" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Clinician name </h3>

<input type="text" name="cp_clinianName_1" id="cp_clinianName_1" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">GMC/NMC/HCPC Number</h3>

<input type="text" name="cp_regNumber_1" id="cp_regNumber_1" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Date &#38; time</h3>

<input type="date" name="cp_date_1" id="cp_date_1" class="form-control" style="width: 100%;"></input>

</div>

</div>

<hr class="cp_separator"/>

<div class="row">

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Designation (grade/speciality)</h3>

<input type="text" name="cp_designation_2" id="cp_designation_2" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Clinician name </h3>

<input type="text" name="cp_clinianName_2" id="cp_clinianName_2" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">GMC/NMC/HCPC Number</h3>

<input type="text" name="cp_regNumber_2" id="cp_regNumber_2" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Date &#38; time</h3>

<input type="date" name="cp_date_2" id="cp_date_2" class="form-control" style="width: 100%;"></input>

</div>

</div>

<div class="row" style="border: 5px; border-style: solid; border-color: #643b5e;">

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Designation (grade/speciality)</h3>

<input type="text" name="cp_designation_3" id="cp_designation_3" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Clinician name </h3>

<input type="text" name="cp_clinianName_3" id="cp_clinianName_3" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">GMC/NMC/HCPC Number</h3>

<input type="text" name="cp_regNumber_3" id="cp_regNumber_3" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Date &#38; time</h3>

<input type="date" name="cp_date_3" id="cp_date_3" class="form-control" style="width: 100%;"></input>

</div>

</div>

<div style="float: right; background-color: #643b5e; padding: 5px;">

<p style="color: #ffffff;">Senior responsible clinician</p>

</div>

</div>

<h2 style="color: #ffffff;">8. Emergency contacts</h2>

<div class="row" style="background-color:#ffffff; border: 2px; border-style: solid; border-color: #54496f; padding: 15px;">

<div class="row hidden-xs">

<div class="col-sm-3">

<h3>Role</h3>

</div>

<div class="col-sm-3">

<h3>Name</h3>

</div>

<div class="col-sm-3">

<h3>Telephone</h3>

</div>

<div class="col-sm-3">

<h3>Other details</h3>

</div>

</div>

<div class="row">

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Role</h3>

<p>Legal proxy/parent</p>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Name</h3>

<input type="text" name="cp_Name_1" id="cp_Name_1" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Telephone</h3>

<input type="text" name="cp_telephone_1" id="cp_telephone_1" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Other details</h3>

<input type="date" name="cp_otherDetails_1" id="cp_otherDetails_1" class="form-control" style="width: 100%;"></input>

</div>

</div>

<hr class="cp_separator"/>

<div class="row">

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Role</h3>

<p>Family/friend/other</p>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Name</h3>

<input type="text" name="cp_Name_2" id="cp_Name_2" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Telephone</h3>

<input type="text" name="cp_telephone_2" id="cp_telephone_2" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Other details</h3>

<input type="date" name="cp_otherDetails_2" id="cp_otherDetails_2" class="form-control" style="width: 100%;"></input>

</div>

</div>

<hr class="cp_separator"/>

<div class="row">

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Role</h3>

<p>GP</p>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Name</h3>

<input type="text" name="cp_Name_3" id="cp_Name_3" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Telephone</h3>

<input type="text" name="cp_Telephone_3" id="cp_Telephone_3" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Other details</h3>

<input type="date" name="cp_otherDetails_3" id="cp_otherDetails_3" class="form-control" style="width: 100%;"></input>

</div>

</div>

<hr class="cp_separator"/>

<div class="row">

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Role</h3>

<p>Lead Consultant</p>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Name</h3>

<input type="text" name="cp_Name_4" id="cp_Name_4" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Telephone</h3>

<input type="text" name="cp_Telephone_4" id="cp_Telephone_4" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Other details</h3>

<input type="date" name="cp_otherDetails_4" id="cp_otherDetails_4" class="form-control" style="width: 100%;"></input>

</div>

</div>

</div>

<h2 style="color: #ffffff;">9. Confirmation of validity (e.g. for change of condition)</h2>

<div class="row" style="background-color:#ffffff; border: 2px; border-style: solid; border-color: #54496f; padding: 15px;">

<div class="row hidden-xs">

<div class="col-sm-3">

<h3>Review date</h3>

</div>

<div class="col-sm-3">

<h3>Designation (grade/speciality)</h3>

</div>

<div class="col-sm-3">

<h3>Clinician name </h3>

</div>

<div class="col-sm-3">

<h3>GMC/NMC/HCPC number </h3>

</div>

</div>

<div class="row">

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Review date</h3>

<input type="text" name="cp_date_9_1" id="cp_date_9_1" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Designation (grade/speciality)</h3>

<input type="text" name="cp_designation_9_1" id="cp_designation_9_1" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Clinician name </h3>

<input type="text" name="cp_clinianName_9_1" id="cp_clinianName_9_1" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">GMC/NMC/HCPC number </h3>

<input type="date" name="cp_date_9_1" id="cp_regNumber_9_1" class="form-control" style="width: 100%;"></input>

</div>

</div>

<hr class="cp_separator"/>

<div class="row">

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Review date</h3>

<input type="text" name="cp_date_9_2" id="cp_date_9_2" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Designation (grade/speciality)</h3>

<input type="text" name="cp_designation_9_2" id="cp_designation_9_2" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">Clinician name </h3>

<input type="text" name="cp_clinianName_9_2" id="cp_clinianName_9_2" class="form-control" style="width: 100%;"></input>

</div>

<div class="col-sm-3">

<h3 class="hidden-lg hidden-md hidden-sm">GMC/NMC/HCPC number </h3>

<input type="date" name="cp_regNumber_9_2" id="cp_regNumber_9_2" class="form-control" style="width: 100%;"></input>

</div>

</div>

</div>

</div>

</div>

Further information: