This policy is applicable to all staff that are responsible for delivery of direct patient care.

Transcription

1 PURPOSE & SCOPE This policy outlines minimum standard of practice required for (BLS) training for staff employed within Northern Health. This policy is applicable to all staff that are responsible for delivery of direct patient care. is the preservation or restoration of life by the establishment and /or the maintenance of airway breathing and circulation and related emergency care. BLS may support the person until advanced life support personnel and equipment is available. techniques include early recognition of cardiac arrest, effective chest compressions, rescue breathing, and early defibrillation using a Semi /Automatic External Defibrillator (SAED/AED). DEFINITIONS Newborn: A child from the first few minutes to a few hours after birth. Neonatal: The first 28 days of life. Infant: A child less than one year of age and includes the neonatal period. Young Child: A child of pre primary and primary school age of 1-8 years of age. Older child: Late primary to secondary school age of 9-14 years. Adult: From 14 years and over. Cardiopulmonary Arre st: Signifies a person who is unresponsive and not breathing normally. Cardiopulmonary Re suscitation: Is the technique of rescue breathing and chest compressions and has 3 major components which are: airway assessment and management, breathing assessment and management and circulation assessment and management. This includes external automated defibrillation. : (BLS) The preservation or restoration of life by the establishment of / or the maintenance of airway breathing and circulation, and related emergency care. AED: (AED) Automated external defibrillator with minimal operator involvement SAED: (SAED) Semi automatic external defibrillator that has verbal prompts for operator PPE: Personal protective equipment, including gloves and safety glasses and protective airway device. OUTCOME Following cardiopulmonary arrest, maintenance of cardiac and respiratory function via effective Basic Life Support measures will be undertaken by staff that are trained in, except when documentation indicating a limitation to treatment has been established. training will utilise evidence based guidelines according to the Australian Resuscitation Council of Australia. Page 1 of 12

2 POLICY The Northern Health Policy on is: practice will be in accordance with current Australian Resuscitation Council Guidelines. This policy provide s Ba sic Life Support principles applicable to all ages. Staff employed at Northern Health are expected to undertake orientation to policy and procedure pertaining to, Code Blue Medical Emergency and Medical Emergency Response/Team and Patient Clinical Deterioration Management Principles in the induction phase of their employment. Staff who are responsible for delivery of direct patient care are required to be competent /confident in and refre sh their skills at least annually. Informal, frequent self asse ssments in Ba sic Life Support technique s, either from performance in clinical practice or through patient based scenario simulation is encouraged. Staff not performing on a regular basis are encouraged to undertake regular refresher training to maintain basic skills. Evidence of level of skill will be recorded in a central database may be discussed with the manager at the performance appraisal. Unless otherwise medically indicated, all people who have a cardiopulmonary arrest must be resuscitated using BLS measure s according to the flow charts in this document. ALS measures may be commenced on arrival of the code blue team or if the staff member is trained in ALS techniques. technique s should be continued until the person re sponds or begins breathing normally, it is impossible to continue, or an appropriately trained healthcare professional takes over or directs that Ba sic life Support measure s be ceased. Personal protective equipment (PPE) should be worn if performing resuscitation, but should NOT delay commencement of CPR unless there is an obvious risk to the person performing CPR. In a life threatening situation employees should endeavour to practice manual handling as per NH policy to the best of their ability. PROCEDURE DEFINITION is the preservation or the restoration of life by the establishment of and/or the maintenance of airway breathing and circulation and related emergency care. Page 2 of 12

3 Management principles of are: early recognition of cardiac arrest, provision of effective chest compressions, minimising interruptions to chest compressions and early undertaking of automated external defibrillation. STAFF LEVEL 2 BLS TRAINING AUDIENCE: NH staff that are responsible for delivery of direct patient care. Pre-Requisite: Level 1 training (See NH Policy and Procedure: Resuscitation Training) BLS training BLS refresher/update via group scenario base Online pre-reading resources Online visual prompts, e.g. Video demonstration of simulated BLS scenario Post performance review as required ASSESSMENT (See also: Australian Resuscitation Council Guideline 2-8, 2010, If there is any doubt as to the diagnosis of cardiopulmonary arrest or unsure of the NFR and Goals of Patient Care status of the person, then BLS should be initiated. The code blue team will make the decision when to stop. DANGER: Assess hazards, risks and safety of self, patient and environment. RESPONSIVE? Is the patient responsive? Verbal and Tactile Stimulation SEND FOR HELP: Initiate emergency response for the area. (444 for all Northern Health sites.) This will include emergency buzzers and phone response. For all external emergencies dial 000 Note time OPEN AIRW AY: Ensure clear and open airway. Assessment of airway takes priority of all other injuries. May require suction if debris noted to mouth and in this case the head may be tilted to the side, Otherwise airway should be opened while victim in supine position. In adult and paediatric patients open airway with a combination of chin lift and backward head tilt. Infants under 1 year of age should have the head position and neck alignment in NEUTRAL position (due to potential to obstruct airway) If airway obstruction is suspected, Follow the management of foreign body airway obstruction principles found in this document. NORMAL BREATHING? Assess for chest rise and fall, listen for the escape of air from mouth or nose and feel for movement of chest and upper abdomen. Page 3 of 12

4 If no breathing is found after opening airway and assessing breathing, Then the staff member must immediately commence 30 chest compressions followed by 2 rescue breaths. Although the risk of disease transmission is low, Staff should use an airway barrier device when giving rescue breaths and it is not encouraged that staff in the hospital environment apply rescue breathing without an airway barrier. START CPR: Give 30 chest compressions followed by 2 rescue breaths. Interruptions to chest compressions should be minimised. Patient should be placed on a firm surface in the supine position. Hands should be placed on the lower half of sternum. Adult: hand position is one hand on top of other. For age 1-8yrs: Use one or two hand technique dependant on size of patient. Infants: should have 2 thumb technique placed between the nipples for compressions. Chest compression depth should be 1/3 depth of chest from anterior to posterior surface. Allow full chest recoil after each chest compre ssion. Rate of chest compression is aimed at achieving over 100 chest compressions per minute. It is advisable to change staff at least every 2 minutes to avoid staff fatigue and promote CPR quality. Staff should be aware of correct body position while undertaking chest compressions to prevent injury to self. CPR prompt or feedback devices may be used to promote CPR quality. Dialysis Considerations in Code Blue Northern Health Haemodialysis machines are not cardiac protected. Defibrillation can result in electrocution of bystanders in direct contact with a haemodialysis machine. Defibrillation of a haemodialysis patient connected to a machine may also divert current to the haemodialysis machine rather than the patient reducing the effectiveness of defibrillation. In case of Code Blue in Dialysis Patients Lie patient flat (the chairs may be altered to enable this) Follow BLS flowchart Establish BLS Prior to defibrillation ensure the patient has been disconnected from the dialysis machine It is the dual responsibility of both the Dialysis staff and the person defibrillating the patient that they have checked the patient has been disconnected from the machine. Fistula needles may be left in situ to give access for advanced medications by the ALS team. In most instances the dialysis staff will have time to return the blood to the patient. However, immediate disconnection can be performed by stopping the blood pump then clamping and cutting both venous and arterial lines. Both methods should be employed only by those trained to do so. In most cases this will be the dialysis staff. Special Consideration for Patients in Hydrotherapy Pool The priority of the staff is to remove the patient from the pool and commence BLS. Airway should be inspected for debris and if required head or body turned to the side to drain debri/water.staff should comply with the aquatic pool rescue policy for information and training regarding pool rescue. Page 4 of 12

5 ATTACH DEFIBRILLATOR: (SAED/AED) Follow prompts a s soon a s it is available Use of SAED/AED is an established component of. Time to defibrillation is critical to increase the likelihood of survival from shockable rhythms. Chest compressions should be continued until prompted to stop for rhythm analysis by the AED/SAED. Pads should be placed on exposed chest in the anterior lateral position (See diagram on pads). Avoid any object underneath the pads. Paediatric AED pads should be used in patients under 25kg in weight and placed in the anterior posterior position. (See diagram on pads) Staff should follow prompts of SAED/AED ensuring safety principles are followed prior to delivery of shock. REASSESSMENT It is recommended that CPR and chest compressions only be interrupted to complete necessary tasks such as defibrillation, rhythm analysis (by the AED or ALS team), if the person shows signs of responsiveness or breathing returns, or if the ALS team tell you to stop. PLANNING (See related Policy and Procedure: NH Resuscitation Equipment ) (See related Policy and Procedure: NH Code Blue and Medical Emergency Team Response) (See related Policy and Procedure: NH Resuscitation Training) (See related Policy and Procedure: NH Advanced Life Support) (See related Policy and Procedure: NH Emergency Procedure Manual) (See related Policy and Procedure: O&G Resuscitation: Neonatal An expanded version of the following principles can be found in the online pre-reading resource package and the Australian Resuscitation Council guidelines at 1. Equipment: Clinical staff have a responsibility to ensure resuscitation equipment is checked on a daily basis and after each use. Clinical staff should have a reasonable working knowledge of resuscitation equipment and its location appropriate to their level of clinical responsibility. Resuscitation equipment should be made available to ensure access to training in resuscitation techniques. In the event of the resuscitation equipment being used, it is the responsibility of the area holding the emergency equipment to restock at completion of event as per the checklist provided. Ideally resuscitation equipment should be standardised through the network where possible. Single use equipment and infection control issues should be considered when selecting equipment. 2. Defibrillator The early use of a Semi/ Automatic External Defibrillator (SAED/AED) is emphasised, as this will reduce mortality from cardiac arrest caused by Ventricular Fibrillation (VF) or pulseless Ventricular Tachycardia (VT). Page 5 of 12

6 If SAED/AED s are placed in paediatric areas then they should incorporate additional devices to deliver appropriate energy and also have paediatric paddles available. However, if the SAED/AED does not have paediatric pads or paediatric mode then it is safe to use the adult pads and adult mode ensuring that the pads don t touch make contact with each other on the chest. It may be reasonable to use the anterior posterior pad position in this case. Patients undergoing extracorporeal treatment (dialysis) must be disconnected prior to any form of Defibrillation (see above) 3. Oxygen and Suction Portable units of Oxygen and suction should be available unless wall units are present. All people should be given 100% Oxygen in the setting of cardiopulmonary arrest until medically directed otherwise. 4. Patient Staff should be aware of Goals of Patient Care status and Do Not Resuscitate orders and these should be communicated to emergency response team as early as possible, and documented as per NH policy documents. Patients should be positioned to enable maximum and safe exposure to the basic life support techniques. 5. Environment Environments should be clear and accessible for emergency team, treatment and resuscitation equipment and privacy should be maintained. 6. Team Roles Emphasis should be placed on effective leadership and early identification of team roles in the event of a cardiopulmonary arrest. 7. Debriefing Critical Incident debriefing and/ or clinical review should be undertaken/offered after each cardiac arrest. 8. Riskman Adverse events during a Code Blue or MET event should be entered into the Riskman (VHIMS) database for later evaluation and analysis by the Safety and Quality team and Resuscitation Program Coordinator. 9. Documentation All cardiac arrest events should be charted as per Arrest Chart for NH. If on a subacute site, SAED/AED memory cards should be transported to TNH site and analysed as per patient management plan. AED/SAED memory cards can be resourced from the Critical Care Department. Should a patient be transferred to an acute facility that is not within NH network, the AED data card should be sent to the CCD at TNH campus for printing and insertion into patient history. RESUSCITATION OF PREGNANT PERSON Early involvement of the obstetrician/specialty service is crucial in the pregnant patient suffering cardiopulmonary arrest. If this occurs, follow BLS guidelines. For effective resuscitation of the mother and fetus, expert help must be obtained; this should include an obstetrician and neonatologist. Page 6 of 12

7 Manually displace the uterus to the left to remove caval compression. Add left lateral tilt if this is feasible (the optimal angle of tilt is unknown). Aim for between degrees. The angle of tilt used needs to allow high quality chest compressions and if needed permit Caesarean Delivery of the fetus. A wedge to enable the displacement of the uterus should be accessed. Consider preparation for emergency Caesarean Section, as the fetus will need to be delivered if initial resuscitation efforts fail. SITE SPECIFIC REPSONSE CRITERIA BROADMEADOWS HEALTH SERVICE Press emergency buzzer. Commence BLS. Dial 444 state type of Code Blue and location, repeat once. If required, call 000 stating Medical Emergency for MICA Service, Broadmeadows Health Service, 35 Johnstone Street, Broadmeadows. Security officer to meet ambulance at designated entrance and direct to location of Code Blue. CRAIGIEBURN HEALTH SERVICE Press emergency buzzer. Commence BLS. Dial 444 and state type of Code Blue and location (pod), repeat once. THE NORTHERN HOSPITAL Press emergency buzzer. Commence BLS. Dial 444 and state type Code Blue, location, room number, repeat once. BUNDOORA EXTENDED CARE CENTRE Press emergency buzzer. Commence BLS. Dial 444 and state type Code Blue, location, room number and repeat once. If required call 000 stating Medical Emergency for MICA service, Bundoora Extended Care Centre, 1231 Plenty Road, Bundoora CARDIOPULMONARY ARREST ON HOME VISIT Staff undertaking home visits are to carry a mobile phone and utilise 000 for an emergency response. The staff member will make appropriate judgement on the level of emergency, action required and commence BLS if required. All staff carrying a CPR kit should be trained in the use of the contents. This includes face masks. All staff should have access to PPE present in this kit. If a medical emergency occurs, Dial 000 and follow emergency response advice via Emergency Operator. Page 7 of 12

8 MANAGEMENT OF FOREIGN BODY AIRWAY OBSTRUCTION/ CHOKING Page 8 of 12

9 BASIC LIFE SUPPORT FOR ADULT, PAEDIATRIC AND INFANTS Page 9 of 12

10 NORTHERN HEALTH BASIC LIFE SUPPORT FLOW GUIDE Danger: Ensure Safety Assess environment for risk to self and patient Position patient supine Note time Response: Assess Patient Response Is the patient responsive? unconscious Verbal and tactile stimulation e.g. sternal rub If person obviously pregnant, consider wedge under right lateral side to aid left lateral tilt Send for Help: Staff Response Dial 444 and state type of Code Blue, location and repeats once (000 if subacute) Identify required equipment Airway: Assess to be Open and Clear Open airway and assess for debris Suction with head on side if debris noted If suspected foreign body progress to foreign body airway obstruction/choking flow chart Airway may be opened by head tilt chin lift Breathing: Assess for Normal Breathing Look, listen and feel for breathing If breathing position on left side, apply oxygen and assess vital signs. If no breathing commence cardiac compressions 30 followed by 2 rescue breaths, (consider application of O2 if available and does not prevent delay in compression) In the healthcare setting an airway device (BMV, guedels, mask) should be utilized. Page 10 of 12

11 Compressions: Effective Compressions for all Ages Correct hand position for all ages Correct depth 1/3 chest with full recoil each compression Compression rate 100/min Compression ventilation ratio 30:2 Minimise interruptions to compressions AED: Effective, Safe and Early Defibrillation Disconnect dialysis machine Turn on and follow prompts Attach SAED/AED as soon as it arrives Pad placement on bare chest (adult and paediatric) Ensure safe defibrillation Continue CPR Rotate staff doing compressions every 2min Continue CPR until otherwise directed or patient becomes responsive or breathes normally Medical and Staff Only : Advanced BLS Roles Establish team leader and designates roles Provide handover to the ALS team (ISBAR) Frequent vital signs and assist basic procedures with ALS team, e.g. cannulation Prepare patient for transport Consideration of GOPC/ NFR, Donation NOK/ Sig other notification Debriefing of staff / clinical review Restock equipment Documentation DECISIONS RELATING TO CARDIOPLUMONARY RESUSCITATION Resuscitation teams should observe legal criteria for advanced directives or Goals of Patient Care / do not resuscitate documentation that may exist for a patient. It is the responsibility of the staff member to be aware of the local laws and regulations surrounding such criteria. Refusal of treatment can be initiated by a competent adult or parent/guardian as per state legal guideline. Identification, documentation and communication of any resuscitation plan should be emphasised. Family members should be given every opportunity to be present in the resuscitation with a hospital supported person. The support person should determine if the family member has the ability to be present. The support person should be allocated by the team leader. Page 11 of 12

12 ASSOCIATED POLICIES/ PROCEDURES NH Policy and Procedure: Resuscitation Training NH Policy and Procedure: Advanced Life Support NH Policy and Procedure: Code Blue and Medical Emergency Team Response NH Policy and Procedure: Resuscitation Equipment NH Emergency Procedures Manual NH Patient Handling: Post Implementation of the No Lift System NH Occupational Health & Safety Policy. NH Policy and Procedure: Medical Emergencies on Home Visits TNH Policy and Procedure: O&G Resuscitation: Neonatal NH Policy and Procedure TNH Nephrology Unit: Emergency Management of Patients Undergoing Dialysis NH Policy Aquatic Pool Rescue NH Policy Goals of Patient Care EVALUATION/ COMPLIANCE/KEY PERFORMANCE INDICATORS 100% of NH staff will attend BLS/MET/Code Blue/Clinical Deterioration Management and response training on induction. 100% of NH staff that are competent in BLS has annual refresher training as per individual determination of level of skill confidence. 100% of NH staff who are responsible for delivery of direct patient care will be competent and confident in Basic Life Support skill delivery. Compliance with Policy and Procedure audited via central database and Riskman (VIHMS) data. Reported to NH Resuscitation Steering Committee, and relevant site resuscitation sub committees. Reported to NH Quality, Safety and Risk Unit. Reported to NH Executive. EXECUTIVE SPONSOR Chief Officer NH. AUTHORS NH Resuscitation Program Coordinator NH Resuscitation Steering Committee Australian Resuscitation Council Guidelines, Australia. Australian Commission on Safety and Quality in Health Care, (June 2011) National Safety and Quality, Sydney, Australia FURTHER INFORMATION Chief Officer Northern Health NH Resuscitation Program Coordinator NH Education Centre Australian Resuscitation Council International Liaison Committee on Resuscitation Page 12 of 12