Cath Molineux - Nurse Consultant (Adults) Shropshire Community Services and Anne Shepherd, Resuscitation Officer Approval process Approved by

Transcription

1 Document Details Title Cardiopulmonary Resuscitation (CPR) and Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) Policy Trust Ref No Local Ref (optional) Main points the document Procedures to be undertaken in relation to CPR and DNACPR. covers Who is the document All clinical staff aimed at? Authors Cath Molineux - Nurse Consultant (Adults) Shropshire Community Services and Anne Shepherd, Resuscitation Officer Approval process Approved by Quality and Safety Operational Group (Committee/Director) Approval Date 05/12/16 Initial Equality Impact Yes Screening Full Equality Impact No Assessment Lead Directors Executive Director of Nursing & Operations & Medical Director Category Clinical Sub Category Review date 05/12/19 Distribution Who the policy will be All Clinical Staff distributed to Method Electronically to senior managers for dissemination and via the Trust intranet for all clinical staff to access Document Links Required by CQC Yes Required by NHLSA No Other Amendments History No Date Amendment 1 July 2014 Amendment to comply with recent court judgment R v Tracey, Breach of Human Rights, Article 8 2 April 2015 Section DNACPR Decision and Recording Trusted Assessment and reviewed within 7 days on transfer into SCHT 3 June 2016 Addition of updated DNACPR form and guidance Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Dec16 Page 1 of 49 Datix Ref:

2 Index: Page 1.0 Introduction Purpose Definitions Duties Resuscitation Standards Mental Capacity Act 2005 (MCA) and Best Interests Advance decisions to refuse life-sustaining treatment Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) Performance Management Training Standards Equipment Defibrillators Prevention of in hospital Cardiac Arrest Monitoring compliance with this policy Consultation References Associated Documents 16 Appendices: 1. Adult Basic Life Support (Community settings including patients own homes) 2. In Hospital Resuscitation Algorithm (Community Hospitals). 3. AED Algorithm (Community Hospitals and locations with an AED) 4. Adult Choking Treatment (Community Hospitals and Community Settings) 5. Paediatric Basic Life Support (Community Hospitals and Community Settings) 6. Paediatric Choking Treatment Algorithm 7. Decision Making Framework 8. Resuscitation Trolley Equipment List and daily checklist 9. Emergency Drugs in General Dental Practice and Medical Emergency and Resuscitation Equipment 10. Summary of BLS/ILS Training Requirements SCHT Staff. 11. Resuscitation Council (UK) Do Not Attempt Cardio Pulmonary Resuscitation Adult Form (2015) 12. Resuscitation Council (UK) guidance for completing DNACPR Form (2015) Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Dec16 Page 2 of 49 Datix Ref:

3 1.0 Introduction A cardiac arrest is the ultimate medical emergency the correct treatment must be given immediately if the patient is to have any chance of surviving. The interventions that contribute to a successful outcome after a cardiac arrest can be conceptualised as a chain the Chain of Survival. The four links of the chain comprise of: early recognition and call for help (i.e. phone 999), early cardio pulmonary resuscitation (CPR), early defibrillation and post resuscitation care.(resuscitation council 2015) Resuscitation Council (UK) 2015 Chain of Prevention 2.0 Purpose 2.1 Based on the guidance and recommendations from the Resuscitation Council (UK) Guidelines issued in 2015, the purpose of this policy is to ensure that Shropshire Community Health NHS Trust (SCHT) has in place a standardised approach in circumstances where a person appears to have suffered cardiac arrest and that staff are enabled to provide a prompt and appropriate response Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Dec16 Page 3 of 49 Datix Ref:

4 2.2 Health care professionals who attempt resuscitation will be expected to employ the highest standard of care in line with the professional codes of conduct. This protocol is intended to support life support techniques across the age ranges and includes: 3.0 Definitions Adult Basic Life Support (Appendix 1) Adult In Hospital Resuscitation (Appendix 2) The use of Automated External Defibrillators (AED) (Appendix 3) Adult Choking Algorithm (Appendix 4) Paediatric Basic Life Support (Appendix 5) Paediatric Choking Algorithm (Appendix 6) Advanced Life Support (ALS) The term ALS describes additional measures aimed at restoring ventilation and a perfusing cardiac rhythm: this is necessary to improve the chance of long term survival Anaphylaxis is an acute life-threatening hypersensitivity reaction and should be considered when there is an acute onset, life threatening airway and/or breathing and/or circulation problems; especially if skin changes present Automated External Defibrillators (AED) The defibrillator itself analyses the cardiac rhythms, and advises whether a shock is indicated or not, and selects the appropriate energy levels according to the current Resuscitation Council (UK) Guidelines. AEDs allow staff such as nurses and physiotherapists to defibrillate prior to the arrival of more expert help. AEDs may be used on paediatric patients however attenuated pads that reduce the energy delivered are used for children weighing less than 25kg. Where possible, AEDs should be avoided in the under one year old age group due to potential problems with rhythm recognition. Basic Life Support (BLS) The purpose of BLS is to maintain adequate oxygenation to the vital organs through maintenance of ventilation and circulation. This is continued until the respiratory/cardiac arrest is reversed, and/or the underlying cause treated, or the resuscitation attempt is stopped. It is therefore a "holding measure" until defibrillation and/or advanced life support is available. Failure of the circulation for three to four minutes (less if the victim is initially hypoxaemic) will lead to irreversible cerebral damage. Delay, even within that time, will lessen the eventual chances of a successful outcome. Emphasis must therefore be placed on prevention of cardiac arrest and early access to help then rapid institution of BLS by a rescuer if required. Basic Life Support with Airway Adjunct Basic life support implies that no equipment is employed. When a simple airway device or facemask is used to assist the delivery of ventilations, this is defined as "basic life support with airway adjunct". Cardiac Arrest Cardiac arrest is the sudden cessation of mechanical cardiac activity, confirmed by the absence of a detectable pulse, unresponsiveness, and apnoea or agonal, gasping respiration. Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Dec16 Page 4 of 49 Datix Ref:

5 Cardiac Rhythms Rhythms associated with cardiac arrest can be divided into two groups: ventricular fibrillation / pulseless ventricular tachycardia (VF/VT) and other rhythms (Non VF/VT). The latter includes asystole and pulseless electrical activity (PEA). The principle difference in the management of these two groups is the need for defibrillation in those patients with VF/VT. Subsequent actions, including chest compressions, airway management and ventilation, venous access, the administration of adrenaline, and the identification and correction of reversible causes, are common to both groups. Cardiopulmonary Resuscitation (CPR) Cardiopulmonary Resuscitation is a combination of artificial ventilation, chest compressions, drug therapy and defibrillation. Chain of Survival The interventions that contribute to a successful outcome after cardiac arrest can be conceptualised as a chain. The four links of the chain comprise of: early recognitionand call for help (i.e. phone 2222/999), early CPR, early defibrillation and post resuscitation care. Clinical Staff A member of trust staff whose job description includes direct patient care. Defibrillation Defibrillation is the definitive treatment for VF and pulseless VT. It involves the delivery of a DC electric shock to the myocardium. The energy level to be administered is defined in the current ALS guidelines by the Resuscitation Council (UK). For defibrillation to be effective, a critical mass of the myocardium needs to be depolarised to allow the heart s own pacemakers to resume control. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) A DNACPR order indicates that in the event of a cardiac arrest, CPR will not be initiated. DNACPR decisions are the overall responsibility of the Medical Practitioner in charge of the patient s care. Attempts at CPR will not be commenced when it is felt that a patient would not survive or when it is not the patient s wishes. It is emphasised that a DNACPR decision does not prevent other forms of treatment being provided. Respiratory Arrest Respiratory arrest is the cessation of spontaneous breathing. 4.0 Duties 4.1 Chief Executive. It is the responsibility of the Chief Executive to ensure that the Trust fulfils its duties under relevant NHS guidance in relation to CPR. 4.2 Medical Director. It is the responsibility of the Medical Director to: Identify nominated Trust Resuscitation Leads with delegated authority as shown below: Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Dec16 Page 5 of 49 Datix Ref:

6 Medical Director Lead GPwSI Diagnostic Assessment and Access to Rehabilitation and Treatment and Associate Medical Director Clinical Director, Shropshire Salaried Dental Service (Resuscitation Lead) Clinical Lead Paediatrics and Associate Medical Director Resuscitation Lead for Community Hospitals and Outpatient Division: Clinical lead for Diagnostic Assessment and Access to Rehabilitation and Treatment Resuscitation Lead for Community Services Division: Consultant Nurse - Adults Resuscitation Lead for Children and Families Division: Consultant Nurse for Complex Children Provide the Resuscitation Leads with the resources to carry out their duties. Provide or commission the appropriate level of CPR training for all staff identified on the training needs analysis (TNA) produced by the Organisational Development (OD) team. Ensure that this policy is effectively distributed and implemented to enable compliance throughout the organisation. 4.3 Trust Resuscitation Leads. It is the responsibility of the Trust Resuscitation Leads/Resuscitation Officer to: Facilitate policy development and supporting procedures. Provide assurance to the Medical Director that the Trust complies with the regulatory requirements of the Care Quality Commission (CQC) and the NHS Litigation Authority (NHSLA). To ensure that training in Basic Life Support (BLS) or Immediate Life Support (ILS) is made available to staff as identified on the TNA in conjunction with the OD team. 4.4 Clinical Services Managers (CSM). It is the responsibility of the CSMs to: Ensure that all the clinical areas under their managerial control have the appropriate resuscitation equipment. Ensure that systems and processes are in place for the checking, storage, servicing, maintenance and decontamination of medical devices. Participate in policy development relevant to their areas and ensure that all areas comply with the resuscitation policy. Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Dec16 Page 6 of 49 Datix Ref:

7 4.5 Team Leaders/Ward Managers. It is the responsibility of Team Leaders and Ward Managers to: Ensure that they and all their staff receive appropriate BLS or ILS training as identified on the TNA. Ensure review of training through appraisal and personal development plans. Take action as required should a member of staff either not complete their mandatory training as identified or are deemed not to have achieved the competency required following training. This will involve additional training to ensure competence is reached. Ensure all resuscitation equipment is checked and recorded according to Trust requirements and that it is always fully functional and fit for use. A system of immediate replenishment should be in place following use. Any faults identified with the equipment should be reported immediately to the appropriate Clinical Services Manager and then repaired by Medical Engineering sergvice (MES) 4.6 All clinical staff. It is the responsibility of all clinical staff to: Undertake annual CPR training as identified in the TNA and to maintain their competencies in resuscitation procedures. Ensure that the directions set out in this policy are adhered to and implemented in practice. 5.0 Resuscitation Standards 5.1 It is the policy of SCHT that CPR will be attempted for all persons requiring help due to a medical emergency or cardio pulmonary arrest. If however, there is a clear indication that resuscitation is not to be performed, then the Do Not Attempt Cardio pulmonary Resuscitation Guidance in section eight below should be followed. 5.2 All arrests should result in the emergency services being called as soon as possible. For guidance on adult CPR procedures, anaphylaxis and the management of choking refer to appendices 1-4. The guidance in this policy follows recommendations by the Resuscitation Council UK (2015). All patients who suffer a cardio pulmonary arrest will be transferred when relevant via the ambulance service for further immediate treatment and then on to an appropriate Accident & Emergency Department for specialist care. 5.3 Where there is no time to establish the medical history and/or in the absence of a prior decision not to resuscitate, CPR must be initiated. This is in accordance with both professional responsibilities and legal obligations. Failure to attempt CPR in this instance may attract legal action against the practitioner and/or the Trust. 5.4 All staff who may be involved in resuscitation decisions have a responsibility to understand and implement this policy. 5.5 Cardiopulmonary arrest is uncommon in infants and children. The fundamental difference between resuscitation of a child compared to an adult is that most children have a healthy heart. It is usual that cardiac arrest occurs following respiratory arrest. 5.6 For guidance on CPR procedures and the management of choking in children refer to Appendices 5 and 6 to this policy. Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Dec16 Page 7 of 49 Datix Ref:

8 6.0 Mental Capacity Act (2005) (MCA) and Best Interests 6.1 As a basic principle, providing staff have complied with the MCA in assessing a person s capacity and have acted in the person s best interests they will be able to diagnose and treat patients without their consent. 6.2 For a person who lacks capacity, then acts done or decisions made must be in their best interest. Where any determination relates to life sustaining treatments, begin with the assumption that it is in the incapacitated person s best interest for their life to continue, for example emergency procedures such as cardiopulmonary resuscitation. 6.3 It will be important to keep a full record of what has happened. The protection from liability will only be available if you can demonstrate that you have assessed capacity, reasonably believe it to be lacking and then acted in what you reasonably believe to be in the person s best interests. In emergencies, it will often be in a person s best interests for you to provide urgent treatment without delay. 6.4 Persons working in health or social care will need to record accurately the decisions they make about the assessment of mental capacity, and the determination of best interests. Staff should remember that the records they keep might in the future be referred to if there is a dispute or as part of legal proceedings. 6.5 The decisions may be recorded in the: Care plan End of life plans clinical records Electronic patient register Medical records Social work records Other health and social care records Other notes and records such as those kept by social workers, therapists or care assistants & interagency records??. 7.0 Advance Decisions to Refuse Life-sustaining Treatment 7.1 The MCA has far reaching effects for people who work in health and social care because it extends the ways in which people using services can plan ahead for the time when they may lack capacity. These may be expressed through an advance decision to refuse certain treatment if they lack capacity. 7.2 Providing care or treatment for people who have made advance decisions is a complex area and it is advisable to refer to Chapter 9 of the Mental Capacity Act Code of Practice for more detailed guidance or the Trust Consent Policy. 7.3 Where it is known that an Advance Decision exists, refer to the SCHT Policy on Advance Decisions available on the Trust intranet. 7.4 Whilst fortunately an infrequent occurrence in paediatrics, there are situations whereby a child s illness is such that cardio-pulmonary resuscitation would not be appropriate. Such a decision is reached only after lengthy discussion with the child s family, and will have involved all key health professionals. The child s lead consultant will be responsible for ensuring any and all decisions are clearly and accurately Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Dec16 Page 8 of 49 Datix Ref:

9 documented in the child s clinical record, and all relevant professionals and family receive written documentation of decisions agreed. In the community setting the Community Children s Nursing Service will initiate an Advance Care Plan [ACP] for a Child or Young Person in conjunction with child s lead paediatrician where all decisions are clearly documented. The ACP has been adopted from the West Midlands Paediatric Palliative Care Network pdf 7.5 For guidance on CPR decision making for competent, non-competent adults and children & young adults refer to Appendix 7 which reflects the decision making framework in a joint statement by the British Medical Association, the Resuscitation Council UK and the Royal College of Nursing (2007) entitled Decisions Relating to Cardiopulmonary Resuscitation. 8.0 Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) 8.1 All patients should be assessed on an individual basis and any decisions made for DNACPR must be in the best interest of the patient and in discussion with the patient, multidisciplinary team and where appropriate the patient s relatives. DNACPR Orders apply solely to the application of CPR or respiratory arrest. Other forms of treatment are not precluded and must not be influenced by a DNACPR Order. (this will be recorded as an alert and may require a form to be filled in on EPR) 8.2 There must be an identified need to consider DNACPR. It is appropriate to consider a DNACPR decision in the following circumstances: Where a patient is in the terminal phase of illness or for whom the burdens of the treatment clearly outweigh the benefits Where CPR is not in accord with the recorded, sustained wishes of the patient who has mental capacity to make the decision Where CPR is not in accord with a valid applicable Advanced Decision Where successful CPR is likely to result in a quality of life that would not be in the best interest of the patient When a clinical decision is made that CPR should not be attempted, because it will not be successful, and the patient has not expressed a wish to discuss CPR, it is not necessary or appropriate to initiate discussion with the patient to explore their wishes regarding CPR 8.3 In all cases the patient and / or their family must be involved in the DNACPR decision, but for some patients, for example those who know that they are approaching the end of their life, making decisions about interventions that would not be clinically successful will be unnecessarily burdensome and of little or no value. An assessment should be made of how much information the individual patient (or, if the patient lacks capacity, those close to them) wants to know. Although patients should be helped to understand the severity of their condition, whether they should be involved or informed explicitly of a clinical decision not to attempt CPR will depend on the individual circumstances. Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Dec16 Page 9 of 49 Datix Ref:

10 8.4 In some cases, the decision not to attempt CPR is a straightforward clinical decision. If the clinical team believes that CPR will not re-start the heart and maintain breathing, it should not be offered or attempted. CPR (which can cause harm in some situations) should not be attempted if it will not be successful. However, the patient s individual circumstances and the most up-to-date guidance must be considered carefully before such a decision is made. 8.5 When a patient is in the final stages of an incurable illness and death is expected within a few days, CPR is very unlikely to be clinically successful. Uncommonly, some patients for whom a DNACPR decision has been established may develop cardiac or respiratory arrest from a readily reversible cause such as choking, induction of anaesthesia, anaphylaxis or blocked tracheostomy tube. In such situations CPR would be appropriate, while the reversible cause is treated, unless the patient has specifically refused intervention in these circumstances. Prolonging life is not always beneficial. The courts have confirmed that it is lawful to withhold CPR on the basis that it would not be in the patient s best interests, where consideration has been given to the relevant medical factors and to whether the treatment may provide a reasonable quality of life for a patient who lacks capacity. 8.6 Responsibility for a DNACPR decision rests with the most senior healthcare professional responsible for the patient s care. When a DNACPR decision is made it should be recorded clearly, together with the reasons for it and the names and designation of those involved in the discussion and decision. If no discussion takes place either with the patient or with those close to them, the reasons for this must be recorded. 8.7 The use of an easily identifiable, dedicated form to record DNACPR decisions is recommended and must be communicated to all relevant health professionals. It is also their responsibility to enter the DNACPR decision in the patient s medical records including the rationale for the decision and those who are involved. DNACPR decisions should be regarded as a Trusted Assessment and reviewed: On transfer into a Community Hospital when clerked or by the next available MDT but within 7 days. The existing DNACPR remains valid until this time Whenever clinically appropriate, but particularly when there is an improvement in the patient s clinical condition The patient and/or relatives/carers ask for it to be reviewed Refer to Appendix 7 for further guidance 9.0 Performance Management Mortality Group. The Mortality Group and its sub groups review all deaths in Community Hospitals and make recommendations for actions where appropriate. Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Dec16 Page 10 of 49 Datix Ref:

11 10.0 Training Standards Shropshire Community Health NHS Trust 10.1 The Trust will ensure that all identified staff are trained to a minimum of BLS (adult) standard and for appropriate staff to Immediate Life Support (ILS) standard. Additional training in Paediatric BLS and the use of Automated Electronic Defibrillator (AED) devices will be necessary for different groups of professionals. Please refer to Appendix 10 for details of training requirements It is the responsibility of each service manager to ensure that training is attended by all identified staff at the appropriate time. However, the individual has a professional obligation to ensure that they are adequately trained to perform the appropriate level of Life Support for their role Training provided will be carried out in accordance with and conform to the Resuscitation Council Guidelines Staff unable to meet the required standard within the training session will be given the opportunity to undertake further training (within an agreed time). If after additional training the required standard is not achieved or in the event that staff members are physically unable to perform to required standards their manager will be contacted and informed. At this point an action plan can be devised to achieve outcomes and realise potential risks and manage them appropriately A full training register will be maintained by the Organisational and Workforce Development Department.and compliance monitored through ESR 10.6 Agency / locum / independent contractors are not included in the Trust s resuscitation training programme. Therefore they are individually responsible for remaining appropriately trained for the role in which they are employed. However, bank staff who are directly employed by the Trust are covered by this policy Equipment 11.1 Basic equipment required for BLS should be available in all health care settings where staff carry out clinical procedur. It is the responsibility of the individual carrying out a clinical procedure to assure that resuscitation equipment is accessible and fit for use and recorded as such Staff carrying out clinical procedures away from the health care setting, such as a patient s home do not normally need to carry resuscitation equipment although it is advisable to carry an airway adjunct e.g. Pocket Mask as a precaution against infection Where specific equipment is required for higher risk procedures such as immunisations, it is expected that staff will not carry out a procedure without the appropriate equipment available For guidance on the minimum level of equipment required for each clinical setting please refer to Appendix There should be a local system for monitoring all resuscitation equipment, to ensure that it is available, has not passed its expiry date, that the packaging is not compromised and that it is fit for purpose. For example each service should have an identified role responsible for checking and recording the state of readiness of all resuscitation drugs (expiry date) and equipment. These checks should be undertaken at least daily and clinical leads for each division/clinical service managersand team Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Dec16 Page 11 of 49 Datix Ref:

12 leaders should ensure that they are recorded so that they provide an audit trail. All staff however have a responsibility to familiarise themselves with the emergency equipment within their clinical environment Where appropriate documented equipment checks should include the following: Tested and electrical safety stickers are within date. Suction equipment performs to its specification. If battery powered, check charging light is on and functional check when disconnected form charger. Ensure oxygen cylinder contains sufficient gas. Check oxygen is present at flow meter outlet when turned on with a maximum delivery of up to 15l/m. Check for leaks. Cleaning of trolley and exposed equipment e.g. AED using detergent wipes to include top, ledges and inside draws etc Where possible all emergency medical equipment should be single use and latex free Dental Practitioners have an obligation to be conversant with current guidelines such as Medical Emergencies and Resuscitation Standards for Clinical Practice and Training for Dental Practitioners and Dental Care Professionals in General Dental Practice issued by the Resuscitation Council (UK) July 2006 and revised in These guidelines state that the equipment used for any medical emergency or cardiopulmonary arrest should be standardised throughout general dental practices in the UK. The equipment and drug list as recommended in the guideline is in Appendix 8 to this policy Defibrillators 12.1 The Resuscitation Council (UK) advise that Electrical defibrillation is well established as the only effective therapy for cardiac arrest due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). The scientific evidence to support early defibrillation is overwhelming, the single most important determinant of survival being the delay from collapse to delivery of the first shock. The chances of successful defibrillation decline at a rate of 7-10% with each minute; basic life support will help to sustain a shockable rhythm but is not a definitive treatment Within SCHT there are Automated External Defibrillators (AED) situated in the following areas: Location Area Type No. Bridgnorth Hospital Theatre AED X 1 Bridgnorth Hospital MIU/DAART AED X 1 Bridgnorth Hospital Ward AED X 1 Ludlow Hospital MIU AED X 1 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Dec16 Page 12 of 49 Datix Ref:

13 Location Area Type No. Ludlow Hospital Dinham AED X 1 Oakengates clinic Oakengates AED X 1 Bishops Castle Hospital clinic Ward AED X 1 Whitchurch Hospital Ward AED X 1 Whitchurch Hospital MIU AED X 1 HMP/YOI Stoke Heath Healthcare AED X 2 MArysville Oswestry Health Centre APCS AED X 1 Oswestry Health Centre MIU/DAART AED X 1 Shrewsbury DAART RSH AED X 1 Castle Foregate Dental AED X 1 Craven Arms Dental AED X 1 Dawley Dental AED X 1 Oswestry Dental AED X AEDs are sophisticated, reliable, safe, computerised devices that deliver electric shocks to victims of cardiac arrest when the ECG rhythm is one that is likely to respond to a shock. Simplicity of operation is a key feature: controls are kept to a minimum, voice and visual prompts guide rescuers. Modern AEDs are suitable for use by both lay rescuers and healthcare professionals All AEDs analyse the victim s ECG rhythm and determine the need for a shock. The semi-automatic AED indicates the need for a shock, which is delivered by the operator, while the fully automatic AED administers the shock without the need for intervention by the operator. Some semi-automatic AEDs have the facility to enable the operator (normally a healthcare professional) to override the device and deliver a shock manually, independently of prompts Smaller paediatric self-adhesive pads that attenuate the delivered current during defibrillation are available for use with AEDs. Standard AEDs are suitable for use in children older than 8 years. In children between 1 and 8 years paediatric pads or paediatric mode should be used if available; if not the AED should be used as it is Prevention of Cardiac Arrest in Community Hospitals 13.1 The Resuscitation Council (2015) recommend strategies for the prevention of in hospital cardiac arrest. The strategies below are applicable in Community Hospitals. Place critically ill patients, or those at risk of clinical deterioration, in areas where the level of care is matched to the level of patient sickness. Monitor regularly such patients using simple vital sign observations (e.g. pulse, blood pressure, respiratory rate, conscious level, temperature and Oxygen Saturation levels (Sp02) Match the frequency and type of observations to the severity of illness of the patient using the national early warning score system. Use a patient vital signs chart that encourages and permits the regular measurement and recording of vital signs and, where used, early warning scores. Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Dec16 Page 13 of 49 Datix Ref:

14 Ensure that the hospital has a clear policy that requires a timely and appropriate clinical response to deterioration in the patient s clinical condition. Introduce into each hospital a clearly identified response to critical illness. Ensure that all clinical staff are trained in the recognition, monitoring, and management of the critically ill patient, and that they know their role in the rapid response system. Empower staff to call for help when they identify a patient at risk of deterioration or cardiac arrest. Use a structured communication tool to ensure effective handover of information between staff (e.g. SBAR - Situation-Background- Assessment- Recommendation). Identify patients who do not wish to receive CPR and those for whom cardiopulmonary arrest is an anticipated terminal event for whom CPR would be inappropriate. Audit all cardiac arrests, false arrests, unexpected deaths, and unanticipated intensive care unit admissions, using a common dataset. Audit the antecedents and clinical responses to these events. Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Dec16 Page 14 of 49 Datix Ref:

15 14.0 Monitoring compliance with this policy Element to be monitored Duties Training Record Keeping Lead Tool Frequency Reporting Arrangements Acting on recommendations and leads Resus Lead Resus Lead Resus Lead Data collection tool Training records Records audit Annual Annual Annual Reports to Medical Devices/CPR group Reports to Medical Devices/CPR group Reports to Medical Devices/CPR group Any changes to process will be identified in this review and notified to the relevant person(s) within a specified timeframe Any changes to process will be identified in this review and notified to the relevant person(s) within a specified timeframe Any changes to process will be identified in this review and notified to the relevant person(s) within a specified timeframe Change in practice and lessons to be shared Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 15 of 49

16 15.0 Consultation. Consultation has taken place with the following members of staff: Dr Emily Peer, Associate Medical Director Steve Gregory, Executive Director of Nursing and Quality Dr Ganesh, Medical Director Cath Molineux, Consultant Nurse for Adults Peter Foord, Risk Advisor Narinder Kular, Consultant Nurse for Children with Complex Needs. Paul Zubkowski, Clinical Director, Dental Services Rita O Brien, Chief Pharmacist Andrew Thomas, Head of Nursing/Quality 16.0 References and Associated Documents Joint Statement: British Medical Association, the Resuscitation Council UK and the Royal College of Nursing (2015) Decisions Relating to Cardiopulmonary Resuscitation. Resuscitation Council UK (2015) 2015 Resuscitation Guidelines, Resus Council UK, London. Trust Policy on Advanced Decisions Trust Consent Policy Dissemination and Implementation Dissemination of this policy will be via the Trust intranet as per the front sheet and training as per Appendix 10 to the policy. Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 16 of 49

17 Adult Basic Life Support (Resuscitation Council 2015) (Community settings including patients own homes) Appendix 1 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 17 of 49

18 Resuscittion Council (UK) 2015 Shropshire Community Health NHS Trust Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 18 of 49

19 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 19 of 49

20 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 20 of 49

21 Appendix 2 In Hospital Resuscitation Algorithm (Resuscitation Council 2015) (Community Hospitals) Collapsed/Sick Patient Shout for help and assess patient NO Signs of Life? YES Dial 999 Assess ABCDE Recognise and treat Oxygen, monitoring, IV access CPR 30:2 With oxygen and airway adjuncts Apply pads/monitor Attempt defibrillation if appropriate Dial 999 Advanced Life Support when ambulance arrives Handover to ambulance crew Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 21 of 49

22 Resuscitation Council (UK) 2015 Shropshire Community Health NHS Trust Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 22 of 49

23 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 23 of 49

24 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 24 of 49

25 AED Algorithm (Resuscitation Council 2015) Appendix 3 (Community Hospitals and locations with an AED) Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 25 of 49

26 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 26 of 49

27 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 27 of 49

28 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 28 of 49

29 Appendix 4 Adult Choking Treatment (Resuscitation Council 2015) (Community Hospitals and Community Settings) Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 29 of 49

30 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 30 of 49

31 Paediatric Basic Life Support (Resuscitation Council 2015) Appendix 5 CALL 999 FOR HELP Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 31 of 49

32 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 32 of 49

33 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 33 of 49

34 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 34 of 49

35 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 35 of 49

36 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 36 of 49

37 Paediatric Choking Treatment Algorithm (Resuscitation Council 2015) Appendix 6 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 37 of 49

38 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 38 of 49

39 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 39 of 49

40 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 40 of 49

41 Appendix 7 Decision Making Framework Sections referred to in the chart below refer to the Joint Statement of the British Medical Association, the Resuscitation Council UK and the Royal College of Nursing (2015) Decisions Relating to Cardiopulmonary Resuscitation. Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 41 of 49

42 Appendix 8 Resuscitation Trolley Equipment List RESUS TROLLEY UPDATE Resus Trolley DAILY CHECK RECORD TAG NUMBER. WEEKLY CHECK OF WHOLE TROLLEY AND REPLACEMENT OF TAG _ RECORD NEW TAG NUMBER week commencing mon tues wed thurs fri sat TOP DRAWER expiry dates POCKET MASK ADULT/CHILD CLEAR FACE MASKS OROPHARANGEAL AIRWAYS nd DRAWER SPARE DEFIBRILATOR PADS RAZOR FOR HAIRY CHEST - SURGICAL TYPE ABSORBANT CLOTH 3rd DRAWER BAG VALVE MASK ADULT BAG VALVE MASK CHILD BAG VALVE MASK INFANT 4th DRAWER PPE GLOVES MED/LRG APRON x4 OXYGEN TUBING/ SUCTION TUBING YANKAEUR X2 ADULT AND CHILD SUCTION CATHETER X2 ATTACHED TO SIDE Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 42 of 49

43 OXYGEN CYLINDER WITH KEY OXYGEN TUBING 5TH DRAWER ANAPYLAXIS PACK ON TOP OF TROLLEY AED PORTABLE SUCTION WITH TUBING AND YAKAUER ANAPYLAXIS BOX CHECKLIST date- Water for injections Normal Saline for Injections Adrenaline Chlorphenamine Hydrocortisone Salbutamol Neb 2.5mg Salbutamol neb 5mg 5ml Syringe 2ml Syringe 1ml Syringe needle 20g needle 21g needle 23g chlorprep gauze expiry mon tue wed thurs fri sat sun Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 43 of 49

44 Emergency Drugs in General Dental Practice and Medical Emergency and Resuscitation Equipment (Resuscitation Council 2012) Appendix 9 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 44 of 49

45 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 45 of 49

46 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 46 of 49

47 Summary of BLS/ILS Training Requirements SCHT Staff. Location Profession Frequency Community Teams including DAART Community Hospitals BLS Adult X ILS Adult Paed BLS X Paeds ILS Appendix 10 AED Anaph ylaxis X Nursing/Doctors Annual Therapist Annual X Health Visitors Annual X X X School Nurses Annual X X X Children s Nurses Annual X X X Registered Nurses/Doctors Unregistered Health Care Assistants Annual X X X Annual X Therapists Annual X Radiographers Annual X Pharmacists Annual X X X Podiatry Podiatrists Annual Prison Registered Annual X X X Healthcare Nurses/Doctors Unregistered Nurses Annual X X X Dental Services Annual X X X Minor Injuries Units Dentists/Dental Nurses Special Care Dentistry and Childrens Dentists, Dental Nurses, Therapists and Hygienist based on dental sites with AED Dentists, Dental Nurses, Therapists and Hygienist Registered Nursing Staff Unregistered Health Care Assistants Annual X X X X Annual X X X Annual X X Annual X X APCS Therapists Annual X X X Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 47 of 49

48 DO NOT ATTEMPT CARDIOPULMONARY RESUSCITATION Name Address Date of birth NHS number Adults aged 16 years and over DNACPRadult.1(2015) Date of DNACPR decision: / / DO NOT PHOTOCOPY In the event of cardiac or respiratory arrest no attempts at cardiopulmonary resuscitation (CPR) are intended. All other appropriate treatment and care will be provided. 1 Does the patient have capacity to make and communicate decisions about CPR? If YES go to box 2 If NO, are you aware of a valid advance decision refusing CPR which is relevant to the current condition? If YES go to box 6 If NO, has the patient appointed a Welfare Attorney to make decisions on their behalf? If YES they must be consulted. YES / NO YES / NO YES / NO All other decisions must be made in the patient s best interests and comply with current law. Go to box 2 2 Summary of the main clinical problems and reasons why CPR would be inappropriate, unsuccessful or not in the patient s best interests: 3 Summary of communication with patient (or Welfare Attorney). If this decision has not been discussed with the patient or Welfare Attorney state the reason why: 4 Summary of communication with patient s relatives or friends: 5 Names of members of multidisciplinary team contributing to this decision: 6 Healthcare professional recording this DNACPR decision: Name Position Signature Date Time 7 Review and endorsement by most senior health professional: Signature Name Date Review date (if appropriate): Signature Name Date Signature Name Date Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 48 of 49

49 This form should be completed legibly in black ball-point ink All sections should be completed The patient s full name, date of birth and address should be written clearly. The date of recording the decision should be entered. This decision will be regarded as INDEFINITE unless it is clearly cancelled or a definite review date is specified. The decision should be reviewed whenever clinically appropriate or whenever the patient is transferred from one healthcare setting to another, admitted from home or discharged home. If the decision is cancelled the form should be crossed through with 2 diagonal lines in black ball-point ink and CANCELLED written clearly between them, signed and dated by the healthcare professional cancelling the decision. 1. Capacity / advance decisions Record the assessment of capacity in the clinical notes. Ensure that any advance decision is valid for the patient s current circumstances. 16 and 17-year-olds: Whilst 16 and 17-year-olds with capacity are treated as adults for the purposes of consent, parental responsibility will continue until they reach age 18. Legal advice should be sought in the event of disagreements on this issue between a young person of 16 or 17 and those holding parental responsibility. 2. Summary of the main clinical problems and reasons why CPR would be inappropriate, unsuccessful or not in the patient s best interests Be as specific as possible. 3. Summary of communication with patient There is a presumption in favour of involving the patient. State clearly what was discussed and agreed. If this decision was not discussed with the patient state the reason. If a patient is in the final stages of a terminal illness and discussion would cause physical or psychological harm without any likelihood of benefit this situation should be recorded. 4. Summary of communication with patient s relatives or friends If the patient does not have capacity their relatives or friends must be consulted and may be able to help by indicating what the patient would decide if able to do so. If the patient has made a Lasting Power of Attorney, appointing a Welfare Attorney to make decisions on their behalf, that person must be consulted. A Welfare Attorney may be able to refuse life-sustaining treatment on behalf of the patient if this power is included in the original Lasting Power of Attorney. If the patient has capacity ensure that discussion with others does not breach confidentiality. State the names and relationships of relatives or friends or other representatives with whom this decision has been discussed. More detailed description of such discussion should be recorded in the clinical notes. 5. Members of multidisciplinary team State names and positions. Ensure that the DNACPR decision has been communicated to all relevant members of the healthcare team. 6. Healthcare professional recording this DNACPR decision This will vary according to circumstances and local arrangements. In general this should be the most senior healthcare professional immediately available. 7. Review / endorsement The decision must be endorsed by the most senior healthcare professional responsible for the patient s care at the earliest opportunity. Further endorsement should be signed whenever the decision is reviewed. A fixed review date is not recommended. Review should occur whenever circumstances change. DNACPRnotes_adult_2015 Cardiopulmonary Resuscitation and Do Not Resuscitate Policy Page 49 of 49