Legal clarity sought after Mulross

The shocking findings of the HIQA report on Mulross Nursing Home, Kilclare has prompted national calls for “legal clarity” on the issue of ‘Do not Resuscitate” orders.

The shocking findings of the HIQA report on Mulross Nursing Home, Kilclare has prompted national calls for “legal clarity” on the issue of ‘Do not Resuscitate” orders.

Standing out among the large list of failings at the nursing home which cared for 24 residents and employed 32 staff, were the orders of ‘Do not Resuscitate’ which had not been discussed with residents, their relatives or members of the multi-disciplinary team.

The HIQA inspectors found no evidence of an assessment of the selected residents or communication of the order with the relevant parties. There was also no care plan in place for the residents under the ‘Do not Resuscitate’ (DNR) order.

Age Action are now calling for “legal clarity” on the DNR order in Ireland as there are no Irish medical guidelines, nor is there any legislation that covers this particularly sensitive area.

Eamon Timmins from Age Action said, “DNR orders exist to enable people to plan for the medical management of the final phase of their life.”

He said, “DNR orders are there to protect the dignity of people, but unless protocols are strictly adhered to there is a risk they can be abused.”

“Do not Resuscitate” or “DNR” is an order to respect the wishes of a patient to not undergo CPR or advanced cardiac life support (ACLS) if their heart were to stop or they were to stop breathing.

According to the Irish Medical Council “such decisions should be made in consultation with the healthcare team, the patient (if possible or advisable) and with the patient’s relatives and carers. The decision, and the reasons for it, should be clearly documented in the patient’s records.”

The Irish Patients’ Association is also calling on Health Minister, Dr James Reilly to contact all nursing home regulatory bodies to see if anything can be learned from the report on the privately run Mulross Nursing Home.

Stephen McMahon of the IPA says further investigations may be needed. Mr McMahon said, “We would like for the Medical Council, the Pharmaceutical Society of Ireland and An Bord Altranais to review this report to see if there are any important lessons for the profession and indeed for them to have further investigations.”

The residents’ reports that were reviewed by HIQA in Mulross were based on residents’ residing at Mulross in December 2012 and January this year.

Residents who transferred from the facility last month along with their families should be able to view all personal and medical records held on them.

It is not clear where the records of deceased residents’ files are stored and whether they can be made available for relatives to inspect.

HIQA inspectors found significant care and welfare issues at Mulross Nursing Home which posed “a serious risk to residents.”

The main findings of the HIQA inspections at Mulross Nursing Home are published on page 4.

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