Medical Staff Induction Resuscitation Service Handbook 2018/19 1
Contents: Introduction to the Resuscitation Service Resuscitation Policies National Early Warning Score Sepsis 2222 Calls SBAR Equipment Education Courses and how to access training 2
Welcome to Abertawe Bro Morganwg University Health Board (ABMUHB) The ABMUHB Resuscitation Service is primarily a training/advisory service working under the direction of Team Leader Mark Dawson and the ABMUHB Resuscitation Committee. We are a clinical team with critical care backgrounds; attending 2222 calls and auditing outcomes, providing resuscitation equipment and organising a broad schedule of training Our Team Members: Mark Dawson Service Lead mark.dawson@wales.nhs.uk Resuscitation Officers Morriston Hospital Emma Crowther Helen Williams emma.crowther@wales.nhs.uk helen.williams23@wales.nhs.uk Singleton Hospital Joanne Roberts joanne.e.roberts@wales.nhs.uk Princess of Wales and Neath Port Talbot Hospitals Greg Fabb Stacey Reed gregory.fabb@wales.nhs.uk stacey.reed@wales.nhs/uk Administrator Janice Morgan training.centre@wales.nhs.uk Training Centre, Phillips Parade, Swansea SA1 4JL 01792 465333 3
It is the individual responsibility of all members of staff to ensure they are familiar with ABMUHB policies and the resuscitation equipment in their area. Additionally, they should maintain the appropriate skill level commensurate with their role (as described in the Resuscitation Policy). We hope this pack serves well to provide an insight into the key information requirement Health Board Resuscitation Policies All policies are available on Clinical online information network (COIN) Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) For each person there comes a time when death is inevitable. It is essential to identify patients for whom cardiopulmonary arrest represents a terminal event in their illness and in whom attempted CPR is inappropriate. It is also essential to identify those patients who do not want CPR to be attempted and who can competently refuse it. Each individual staff member is responsible for their own actions and professional practice. Staff involved in discussing and communicating DNACPR decisions have a responsibility to ensure that they are adequately trained to do so. DNACPR decisions for adults over the age of 16 years must be recorded on a dedicated Do Not Attempt Cardiopulmonary Resuscitation form. Guidance on how to complete this form is provided within the Sharing and Involving Do not Attempt Cardio-pulmonary Resuscitation (DNACPR) forms for Adults in Wales book. (Additional information and useful guidance can be accessed at http://talkcpr.wales) Resuscitation Policy The provision of an efficient, expedient and effective response to victims of cardiopulmonary arrest must be an operational priority within every hospital. All Health Board employees must be aware of the ABMUHB policy on cardiopulmonary arrest and their responsibilities within it. The policy outlines roles & responsibilities for all employees. It contains examples of documentation and site specific variations. This policy is maintained by the Resuscitation Committee Training Strategy The training strategy outlines levels of training for all staff groups. 4
Example Documentation (Within the resuscitation Policy) National Early Warning Score (NEWS) Sepsis Screening Tool Situation Background Assessment Recommendation (SBAR) Do not attempt cardiopulmonary resuscitation (DNACPR) National Early Warning Score The National Early Warning Score (NEWS) is a standard operating procedure for scoring vital signs and escalating treatment and monitoring of deteriorating patients. It is recommended for the use on adult patients (16 yrs +) in ABMUHB s acute hospitals. It must be followed by all staff who record patient observations or who respond to deterioration i.e. medical, nursing and allied health professionals. NEWS is not a substitute for sound clinical judgment; it represents the minimum standard of care. Exceptions Where clinical assessment indicates urgent treatment or escalation is not required the rationale must be recorded For patients with chronic conditions resulting in consistently high NEWS, medical staff may amend actions and/or trigger points accordingly e.g. NEWS of 6 normal for this patient, only escalate if 7 or more. This must be documented on the observation chart and in the clinical notes with a date, time and signature The NEWS itself should not be customised, only the triggers and actions should be amended Sepsis The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis- 3) (JAMA. 2016;315(8):801-810.) agreed that sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Multiple definitions and terminologies are currently in use for sepsis, septic shock, and organ dysfunction, leading to variation in reported incidence and observed mortality. The task force concluded the term severe sepsis was redundant. http://jamanetwork.com/journals/jama/fullarticle/2492881. Sepsis is likely to account for at least 44,000 deaths annually in the UK, more people die of sepsis than deaths from bowel and breast cancer combined It is estimated that one third of in- patient deterioration episodes are due to sepsis. 5
Early stage Sepsis is difficult to recognise but easy to treat. Mortality is less than 10%. Sepis schock is easy to recognise but very difficult to treat. Mortality 28-50% The NEWS triggers the use of a sepsis screening tool for all new or worsening episodes of deterioration. Early interventions (Sepsis Six) are detailed within the screening tool. 2222 Calls A 2222 will be made in response to a confirmed cardiac arrest or for a patient who shows signs of acute deterioration e.g. a NEWS of 14 or following A-E assessment. If you are the bleep holder you will be expected to respond in a timely manner. On arrival at the call consider the optimal number of team rescuers; the ideal is rarely greater that 6. If there are sufficient numbers present, with the necessary skills consider returning to normal duties. Post event, document the episode in the medical record and consider a team debriefing (forms for both can found in the top draw of the resuscitation trolley). Key points A cardiac arrest/medical emergency team exist on most on most Health Board sites. The number for summoning team is 2222. Some smaller/peripheral hospitals only have access to 999 system, check locally for the correct procedure Team members should be trained to an appropriate standard i.e. ALS, EPALS Adult, Paediatric, Neonatal and Obstetric teams are available, depending on location Clearly document management provided in the medical record Post incident debriefing is encouraged SBAR (Situation Background Assessment Recommendation) Situation Background Assessment Recommendation The HB endorses the use of standardised communication tools Tools such as SBAR can improve how we communicate, verbally or in documenting events. These devices are widely used in health settings across the UK. Their use promote efficient and effective communicate, improving patient safety All staff should use, and encourage other to use, SBAR whenever possible 6
Equipment All sites within the Health Board have standardised resuscitation equipment. The content lists for resuscitation trolleys and bags can be found within the Resuscitation Policy within COIN. Defibrillators There a mixture of manual and automated machines available within the HB. The majority of the defibrillators are manufactured by Phillips. The only exception is within the ED at Morriston. There are two types of Automated External Defibrillators (AED), both operate on battery only. Phillips FR2 Phillips FR3 (replacement for FR2) Three types of manual defibrillators all have an AED component. All operate on mains or battery. Phillips XL Phillips XL+ Phillips MRX All defibrillators are hands free (except for the burns unit at Morriston) and use the same single use pads and connectors. Take the time to familiarise yourself with the equipment in your area. As a general rule; if a patient is in a shockable rhythm, successful cardioversion is best achieved with a quick shock, regardless of machine type. Some of these defibrillators have facilities to allow external pacing. Machines with pacing can be found in acute areas e.g. CCU, ITU Theatres 7
Intraosseous access and Capnography EZ-IO driver (Intraosseous access drill) and Capnography (EMMA device) will be brought to all calls by a designated member of the 2222 team. Generally it will be ITU resident or similar. EZ IO EMMA ETC02 CPR Compression devices There are Lucas 3, compression devices in the Emergency Departments at Morriston and Princess of Wales hospitals. The HB also has one Zoll Autopulse device, is located in the cardiac catheter lab at Morriston 8
Education E-learning The following certificated training modules are available via ESR and at Learning@wales.nhs NEWS An interactive presentation that outlines the steps involved in creating a NEWS score and the importance of standard operating procedures. NEWS- an introduction for medical staff. It describes the role and responsibilities of those responding to NEWS. It offers advice on accommodating chronic conditions and documentation There are also modules on A-E assessment Sepsis DNACPR Basis CPR Anaphylaxis In-house training Basic life support skills are taught as part of Emergency Life Support (ELS) sessions delivered at Morriston, Singleton, Princess of Wales and Neath Port Talbot hospitals. There are also session provided at the Training Centre at Phillips Parade Swansea. Dates and times can be found at the Learning & Development page on the HB intranet front page. Courses All of the following courses are approved- Immediate Life Support (ILS) provider Paediatric Immediate Life Support (PILS) provider Advanced Life Support (ALS)* European Paediatric Advanced Life Support (EPALS)* Neonatal Advanced Life Support (NALS)* * Please note that there is a fee for these courses. A list of current courses can be found at Learn & Development page, together with booking instructions 9