Resuscitation Policy (NHS Borders)

4.1 Resuscitation

Resuscitation is general term used to describe various emergency treatments to correct life-threatening physiological disorders in a critically ill person. For example, ‘fluid resuscitation’ refers to rapid delivery of fluid into the bloodstream of a person who is critically fluid-depleted. Rapid blood transfusion for someone with severe bleeding is another example. Cardiopulmonary resuscitation (CPR) is sometimes referred to as ‘resuscitation’ but is a specific type of emergency treatment that is used to try to restart the heart and breathing (see CPR below).

4.2 Cardiopulmonary Resuscitation (CPR)

Cardiopulmonary Resuscitation includes all the procedures, from basic first aid to advanced medical interventions, that can be used to try to restore the circulation and breathing in someone whose heart and breathing have stopped. The initial procedures usually include repeated, vigorous compression of the chest, and blowing air or oxygen into the lungs to try to achieve some circulation and breathing until, for example, where appropriate, an attempt can be made to restart the heart with an electric shock (defibrillation).

4.3 Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)

Do Not Attempt Cardiopulmonary Resuscitation decisions have also been called DNR, DNAR or ‘Not for Resuscitation’ (NFR) decisions or ‘orders.’ They refer to decisions made and recorded to recommend that CPR is not attempted on a person should they suffer cardiac arrest or die. The purpose of a DNACPR decision is to provide immediate guidance to health or care professionals that CPR would not be wanted by the person or would not work or be of overall benefit to that person. This tries to ensure that a person who does not want CPR or would not benefit from it is not subjected to CPR and deprived of a dignified death or, worse still, harmed by it.

4.4 Resuscitation Officer (RO)

A non-medical health professional who is responsible for the training of staff in the: recognition of deterioration, and resuscitation, technique; attendance at cardiac arrest and other medical emergencies; and involvement in the recommendations for equipment and organisation to deal with such emergencies

The organisation has an obligation to provide an effective resuscitation service to their patients, and appropriate training to their staff. A defined management structure is required to establish and to provide continued support for these activities.

5.1 Responsibilities within the organisation

5.1.1 NHS Borders Chief Executive

• Designate responsibility to ensure that a resuscitation policy is agreed, implemented and regularly reviewed.
• Have overall responsibility for the implementation of the Resuscitation Policy
• Provide resources required to ensure effective implementation of the policy - Ensure through Clinical Governance strategies/structures that standards are monitored.

5.1.2 NHS Borders Resuscitation Committee

It is the responsibility of the Resuscitation Committee to ensure policy distribution, implementation, and compliance throughout the organisation. This is put into effect at local level.

The Resuscitation Committee minutes are fed into the Acute Clinical Governance Board.

5.1.3 Local line managers

It is the responsibility of managers to ensure that:

• Accept operational responsibility for the implementation of the Resuscitation Policy
• Ensure training needs analysis through risk assessment takes place to identify the appropriate level of training for their staff group
• Disseminate the procedures and safe systems of work into practice which are designed to eliminate or minimise the risks associated with resuscitation
• Ensure the resuscitation equipment is cleaned, maintained, checked in line with Policy
• Ensure resuscitation equipment is in date
• Ensure suitable storage, as appropriate, is provided for the safe keeping and access to the equipment
• Ensure appropriate Moving and Handling emergency lifting equipment is available
• Ensuring that staff required to use resuscitation equipment are provided with necessary instruction  and training, specifically in the use, storage, daily/weekly checks of equipment and cleaning/maintenance regime
• Ensure records are kept of the training - Ensure Bank/Agency staff are familiar with the location and use of the equipment
• Managers must ensure notification of staff (including new starters and leavers) requiring health surveillance to the Occupational Health Services
• Report any defects/concerns to the Resuscitation Officer

5.1.4 All NHS Borders staff

It is the responsibility of individual staff members to:

• Adhere to the Safe Systems of Work relating to resuscitation
• Attend training appropriate to their role
• Use, care for and store resuscitation equipment as per instructions
• Report any faults/defects to the Line Manager and record on the adverse event system.

5.1.5 Resuscitation Officer

It is the responsibility Resuscitation Officer (RO) to ensure that:

• Individual clinical areas have an up-to-date list of the specified equipment and its procurement. The clinical area will have responsibility for the availability of this equipment and any regular checks and tests.
• Checks and tests are performed daily, less frequent checks may be appropriate in certain areas provided this is agreed with the RO.
• Checks and tests are documented locally and are periodically audited by the RO. In
• Responsibility for incident reviews
• Attend Cardiac Arrests/medical emergencies
• Debriefing after cardiac arrests/medical emergencies
• Risk assessments, Data collection and audit of cardiac arrests
• Informing the appropriate managers of safety concerns with regards to Cardiac Arrests/medical emergencies

5.2 Emergency Teams BGH only (2222 response)

5.2.1 Resuscitation Team Lead

• Implement the Resus Huddle (daily basis)
• Distribute roles
• Attend 2222 and assume leadership role
• Complete the Resuscitation Audit sheet and return to the Resuscitation Officer
• Record any adverse events/injuries on Adverse Event Recording System

5.2.2 Resuscitation Team

The resuscitation team comprises of medical staff, critical care outreach staff, hospital at night staff, and bleep holders.

Their responsibilities are to:

• Attend the 9.00am Resus Huddle (as and when on shift)
• Handover of bleeps from Night Shift to Day Shift
• Roles will be distributed to the team by the Resuscitation Team Lead
• Attend 2222 calls throughout their shift, administering emergency treatment in line with training and RCUK guidance

5.2.3 Calling Resuscitation Team or 999

Due to operational variation across NHS Borders sites, each site has a Standardised Operational Procedure which details the procedure to follow in the event of cardiac arrest or medical emergency occurring on that site. The SOP may cover several teams such as adult, paediatric, obstetric and neonatal, depending on that particular site.

Where hospitals have a designated cardiac arrest team then a 2222 call is made to activate the call system and summon the team. The caller is required to state:

• the nature of the emergency, for example cardiac arrest or medical emergency
  
  
• the team required (on sites where there are more than one)
  
  
• the ward or department
  
  
• the hospital site they are calling from

999 Calls

• Locations out with the BGH footprint, such as BGH car parks, Education Centre, Huntlyburn etc Community Hospitals, Health Centres, Community settings, Estates, etc there would be a requirement to call 999, these locations do not have a 2222 system.

5.3 Training

The Resuscitation Service is responsible for providing a comprehensive programme of training suitable for all members of staff. The level of training offered to individual staff members will be appropriate to factors such as role, location, and experience. Managers should use the NHS Borders Statutory/Mandatory Training Matrix to assist them in identifying the appropriate training level for their staff group.

To ensure competency, practical training for staff is mandatory and must be updated as per the NHSB Training Matrix guidance.

5.3.1 Manual Handling

Line Managers should risk assess their staff, if required to undertake resuscitation training, it is advised that these staff undertake the full patient moving and handling courses which includes emergency situations.

Manual Handling in situations where the collapsed patient is on the floor, in a chair or in a restricted or confined space, the organisational guidelines for the movement of the patient must be followed to minimise the risks of manual handling and related injuries to both staff and the patient. Please also refer to https://www.resus.org.uk/library/publications/publication-guidance-safer-handling

5.3.2 Infection Prevention

All clinical areas will have immediate access to airway devices to remove the need for mouth-to-mouth. However, in situations where airway devices are not immediately available, start chest compressions whilst awaiting resuscitation equipment/emergency response.

5.4 Resuscitation equipment and drugs

The Resuscitation Committee will ensure that, as far as practically possible, resuscitation equipment and drugs are standardised across sites. The Resuscitation Committee will provide specifications for equipment which must be available and will take account of the nature of the area which may require deviation from that standard.

5.4.1 Equipment

As per RCUK guidance,

• all defibrillators located within clinical areas should be accessible within three minutes.
• stored within appropriate clinical areas or purpose-built cabinets.
• signage will help to locate equipment storage areas.
• Defibrillators should be clean with no evidence of damage (Resus ready)
• Cleaned to standard infection control standards.
• Adult pads should always remain attached to the defibrillator.
• Paediatric pads are available for children under 8 years (<25Kg), these must be available in areas where children are routinely cared for.

Some items of equipment are held centrally and taken to the location of the emergency when required. Where this is the case, local resuscitation trolleys will indicate where these items of equipment are held and how they are obtained.

The ROs will ensure that individual clinical areas have an up-to-date list of the specified equipment and its procurement. The clinical area will have responsibility for the availability of this equipment and any regular checks and tests. Checks and tests are generally performed daily, however less frequent checks may be appropriate in certain areas provided this is agreed with the RO. Checks and tests are documented locally and are periodically audited by the RO.

5.4.2 Pharmacy

The Resuscitation Committee will define what drugs are to be made available in clinical areas based on the current resuscitation guidelines. Will ensure the availability of cardiac and peri arrest drugs, distribution of these drugs and report drug supply issues to the Resuscitation Committee for resolution.

5.5 Audit of 2222 calls (BGH only)

For all 2222 calls, a Resuscitation Record Form must be completed and returned to the local RO. These forms are available with all resuscitation equipment. This allows the collection of data relating to cardiac arrests and medical emergencies occurring on each hospital site.

5.5.1 Switchboard

Telephone switchboards keep a record of the calls made, allowing the RO to identify where forms have not been completed, and enabling the follow-up of those events. Data from these calls is held on a central database which allows reporting on organisational, hospital and directorate levels.

5.6 Do not attempt cardiopulmonary resuscitation (DNACPR)

The NHS Scotland Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Policy outlines the process and provides guidance relating to the process of decision-making, discussion, recording, and communication of resuscitation decisions, including where the patient may lack capacity. The ROs support this policy and provide ongoing education and support. The Association of Anaesthetists of Great Britain and Ireland provide guidance on DNACPR in patients undergoing anaesthesia.

5.7 Children and young people acute deterioration management (CYPADM)

NHS Scotland Children and Young People Acute Deterioration Management (CYPADM) outlines the process of decision making, discussion, recording and communication of treatments which may be limited or not indicated in the care of children and young people. 

For further information  Treatment and care towards the end of life - professional standards - GMC (gmc-uk.org) 

The approval role for materials associated with this policy is the responsibility of the NHS Borders Resuscitation Committee.

https://www.resus.org.uk/library/2021-resuscitation-guidelines

Site specific Standard Operating Procedures

NHS-Borders Resuscitation Committee meetings are held currently four times per year. These are multidisciplinary, with representatives invited from medical (including site leads of resuscitation) and nursing staff, as well as ROs, pharmacists, medical physicists, and medical staff representing audit and clinical governance. This comprehensive range of stakeholders meet regularly to influence the practical aspects of shaping policy application.

The policy will be reviewed, as a minimum every three years or before, should changes to current guidance take place.

This policy will be monitored via the Audit of 2222 workstream, and ongoing review of guidance and best practice.

This Policy will be the responsibility of the Resuscitation Committee to ensure policy distribution, implementation, and compliance throughout the organisation.

The Resuscitation Committee, for reporting and assurance will report into the Acute Clinical Governance Board, then for upward escalation to the Operational Planning Group and ultimately Borders Executive Team.

Adult Resus Trolley Equipment List 2019 1 (1)

Action Plan - what to do in an Emergency