Resuscitation and Management of Deteriorating Patient

Resuscitation and Management of Deteriorating Patient Who Should Read This Policy Target Audience All Clinical Staff Version 1.1 January 2017

Ref. Contents Page 1.0 Introduction 4 2.0 Purpose 4 3.0 Objectives 4 4.0 Process 5 4.1 Recognition of Patients at Risk - NEWS 5 4.2 Cardiopulmonary Resuscitation (CPR) 5 4.3 Special Circumstances in Resuscitation 6 4.4 Debriefing Staff/ Patients 7 4.5 Informing Next of Kin 7 4.6 Trust Response to Requests the Use of Medical Equipment by Members of the General Public 7 5.0 Procedures connected to this Policy 8 6.0 Links to Relevant Legislation 8 6.1 Links to Relevant National Standards 9 6.2 Links to other Key Policies 10 6.3 References 11 7.0 Roles and Responsibilities for this Policy 12 8.0 Training 16 9.0 Equality Impact Assessment 16 10.0 Data Protection and Freedom of Information 17 11.0 Monitoring this Policy is Working in Practice 17 Version 1.1 January 2017 2

Explanation of terms used in this policy Resuscitation and Management of Deteriorating Patient Basic Life Support (BLS) - Basic life support refers to maintaining airway patency and supporting breathing and the circulation without the use of equipment other than a protective device Enhanced Life Support (ELS) BLS (as above) plus the use of an AED and the use of the ABCDE assessment and treatment plan Immediate Life Support (ILS) - The provision of the knowledge and skills needed to recognise and manage the patient in cardiac arrest by following the advanced life support algorithm. This will include ABCDE assessment, management of the deteriorating patient, basic life support, airway management (igel) and safe use of the automated external defibrillator (AED). This will also include the administration of drugs, depending on the competencies of the member of staff Cardiopulmonary Resuscitation (CPR) - CPR involves chest compressions in an effort to create artificial circulation by manually pumping blood to the brain. In addition, the rescuer may provide breaths by either exhaling into the subject's mouth or nose or utilising a device that pushes air into the subject's lungs Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) - The purpose of a DNACPR decision is to provide immediate guidance to those present (mostly healthcare professionals) on the best action to take (or not take) should the person suffer cardiac arrest or die suddenly National Early Warning Score (NEWS) - The NEWS, like many existing EWS systems, is based on a simple scoring system in which a score is allocated to physiological measurements already undertaken when patients present to, or are being monitored in hospital. Six simple physiological parameters form the basis of the scoring system: respiratory rate, oxygen saturation, temperature, systolic BP, pulse rate, level of consciousness. A score is allocated to each as they are measured, the magnitude of the score reflecting how extreme the parameter varies from the norm. The score is then aggregated Local Protocol - The expected procedure to be carried out within the specified work area Patient Within this Policy this refers to any person (service user, members of staff or visitor) whose physical health has deteriorated in any significant way Version 1.1 January 2017 3

1.0 Introduction Resuscitation can prevent irreversible cerebral damage or death due to anoxia/hypoxia by restoring effective ventilation and circulation. However, most in hospital cardiac arrests are not sudden or unpredictable events. In approximately 80% of cases clinical signs deteriorate over the hours prior to arrest. It is the Policy of Black Country Partnership NHS Foundation Trust (hereafter referred to as the Trust) that all staff has the knowledge, skills, training and equipment to assess and treat the deteriorating patient and to carry out resuscitation. Cardio-pulmonary Resuscitation is required if there is no breathing and signs of life (including pulse checks only if trained to do so). In all such circumstances Basic Life Support must be initiated. It must be recognised that not all resuscitation attempts are successful despite best efforts, and it is important that emergency medical aid is sought immediately to improve the possibility of a successful outcome. If there is any doubt about the resuscitation status of a patient, then clinical staff should attempt resuscitation as outlined in the procedure. The Trust will take all reasonable steps to provide basic life support in all instances of cardiopulmonary arrest and refer for subsequent specialist treatment and care. 2.0 Purpose This policy sets out arrangements for the recognition of the deteriorating patient and management of anyone suffering from an unexpected cardiac arrest (Resuscitation Council, 2015). This is also in line with the Quality Standards for Cardiopulmonary Resuscitation Practice and Training: Mental Health In patient care 2014. The purpose of this policy is to provide direction and guidance for the co-ordinated approach to identifying any physiological changes in patients and the subsequent actions that aim to prevent further deterioration and possible subsequent cardiorespiratory arrest by seeking expert help in a timely manner. 3.0 Objectives This policy covers all staff and sites across the Trust This policy takes into account all the recommendations made by the Resuscitation Council (UK) with regard to matters concerning resuscitation, as part of the Trusts duty of care The Trust will ensure that any patient, visitor or member of staff who experiences a respiratory or cardiac arrest, while on Trust premises or when being seen by a member of Trust staff, will receive an appropriate response which will maximise their chances of survival The Trust delivers care in a wide variety of settings. As a result of this, it is not possible for the Trust to offer the same resuscitation response across all of its services The purpose of this policy is to identify the level of response, training and equipment requirements for each area (see Levels of Response). The levels will be as follows: - Basic Life Support (BLS) - The staff will provide BLS to the patient in cardiac arrest. This may include using the AED if available Version 1.1 January 2017 4

- Enhanced Life Support Plus (ELS) - The staff will provide ELS to the patient in cardiac arrest depending on the equipment and drugs that they have available - Immediate Life Support (ILS) - Staff with responsibility to respond to medical emergencies will provide ILS depending on their skills and competencies All areas that are identified as having an ILS response must ensure that the following team members are available to respond to all medical emergency calls for the time specified: - Team Leader - Medic or Senior Nurse with ILS competence - ELS Responder - ELS competent member of staff to support the team leader 4.0 Process The roles and responsibilities for managing the deteriorating patient and resuscitation are detailed in Section 7.0 Roles and Responsibilities for this Policy. 4.1 Recognition of Patients at Risk - NEWS National early warning score must be implemented for all patients who are at risk of deterioration with their physical health and the appropriate documentation should be in place to ensure that the correct escalation plan is activated. 4.2 Cardiopulmonary Resuscitation (CPR) All procedures must follow the Resuscitation Council UK guidelines (see Algorithms) 4.2.1 When not to commence CPR CPR is mandatory on any person who suffers a cardiac and/ or respiratory arrest unless they have conditions unequivocally associated with death. These are: Massive cranial or cerebral injury Hemicorporectomy Massive truncal injury Decomposition or putrefaction Incineration Hypostasis Rigor mortis 4.2.2 Do Not Attempt Resuscitation For full guidance see Decisions relating to Cardiopulmonary Resuscitation (3rd Edition) https://www.resus.org.uk/dnacpr/decisions-relating-to-cpr/ Do Not Attempt Resuscitation (DNACPR) decision applies solely to Cardiopulmonary Resuscitation (CPR) All other treatment and care should be continued and not be influenced by the DNACPR decision. 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 or anaphylaxis. In such situations CPR would be appropriate unless the patient has specifically refused intervention in these circumstances. If CPR is to be attempted, it should be performed competently in all situations. It is inappropriate to initiate resuscitation and then not to try hard to achieve a successful outcome. Version 1.1 January 2017 5

If CPR is to be attempted, it should be performed competently in all situations. It is inappropriate to initiate resuscitation and then not to try hard to achieve a successful outcome. 4.3 Special Circumstances in Resuscitation The Management of Deteriorating Patient and Resuscitation Policy must be adhered to at all times however some circumstances may require further consideration. 4.3.1 Paediatrics The Resuscitation Council (UK) recognises 4 subgroups amongst children: A newborn is a child just after birth A neonate is a child in the first 28 days of life An infant is a child under 1 year A child is between 1 year and puberty From puberty children should be treated as adults for resuscitation. These definitions should be viewed as developmental rather than chronological. All children should receive resuscitation and staff should utilise adult guidelines if not trained in specific paediatric resuscitation. All Clinical staff working with children will undertake appropriate paediatric resuscitation training (see Training documents) The Trust will provide paediatric basic life support (using the paediatric modifiers to the adult BLS guidelines) until the ambulance service arrive and take over the emergency care to any child who is an cardiopulmonary arrest. All Clinical staff working in areas that manage paediatric patients will commence paediatric basic life support. The ILS responders (if available) will assist with resuscitation to the level of their ability and resuscitation equipment available until the ambulance arrives. All Trust staff who suspects a child of any age may require resuscitation must adhere to local protocol in order to summon the appropriate response and ensure that they state that the casualty is a child. Non-clinical staff should summon help of a Clinical staff in a Clinical environment or a First Aider, if available, in a non-clinical area and/or render assistance to the casualty according to their abilities. 4.3.2 Other Considerations The ILS responders must ensure that they adhere to any specific protocols for specialised areas or situations to ensure safety (patients in isolation, Intensive care areas, hostage scenarios etc.). If a patient s condition is of urgent concern to the staff present, the emergency number or PIN activation can be used to call the ILS responders, the patient s own medical team or an ambulance. Non-Clinical staff, including switchboard/ reception staff are not expected to diagnose cardiopulmonary arrest and therefore emergency calls that are made with an undefined diagnosis will be put out to the ILS responders and/or Ambulance call so that they can respond with best speed. Version 1.1 January 2017 6

A clinical review maybe initiated following a medical emergency, this is to be commissioned by the Associate Medical Director. 4.4 Debriefing Staff/ Patients Debriefing following a medical emergency must be handled with sensitivity and the object is to learn lessons from the incident and allow those involved an opportunity to discuss their feelings and thoughts in a constructive way. A nominated member of staff, who has the appropriate knowledge and skills relating to resuscitation and debriefing wherever possible, will facilitate all debriefings. Following a medical emergency, all Staff participating or witnessing the resuscitation will be offered an opportunity to debrief. Debriefing of a medical emergency should occur wherever possible within 7 days of the medical emergency incident. A meeting of patients (if a medical emergency occurs on a ward/ Residential unit) is to be convened and the patients/ residents are to be offered support and information regarding the incident within 24 hours. Consideration must be given to the confidentiality of the patient concerned at all times. 4.5 Informing Next of Kin Staff will inform the next of kin of the incident, outcome and location of the person resuscitated if this is a service user. Relatives witnessing resuscitation being undertaken by staff on Trust premises will be informed and supported as per guidelines. The operational manager will inform the next of kin of the incident, outcome and location of the person resuscitated if this is a staff member. The operational manager will take steps to find out who the next of kin is if this is a visitor, inform them of the incident, outcome and location of the person. 4.6 Trust Response to Requests the Use of Medical Equipment by Members of the General Public There is increased public awareness of the effectiveness of External Automated Defibrillators in cardiac arrest. It is conceivable that, in the event of a cardiac arrest in the vicinity of one of the Trust sites, a member of the public may present at that site requesting use of an Automated External Defibrillator. The response to this will be: If a member of the public presents at one of the Trust sites requesting the use of an Automated External Defibrillator, then this should be made available immediately A suitably trained member of Trust staff will go with the member of the public to provide assistance with the resuscitation (and to ensure that the AED is returned). This member of staff should be a registered healthcare professional. The member of staff would be expected to provide the same level of assistance that they would if they encountered a cardiac arrest outside of the workplace, namely Basic Life Support and use of the AED Pre-hospital care is a specialist area of clinical practice and so Trust staff are not expected to take the emergency bags with them to provide an ELS or ILS response Version 1.1 January 2017 7

It is anticipated that this would be an extremely rare occurrence and would only happen if a member of the public collapsed within view of one of the Trust sites. Trust staff are only expected to attend the scene of the emergency if it is safe to do so, it is within walking distance of the Trust site and should under no circumstances get into a vehicle to be taken to the scene of the emergency. If the member of staff is unable to ensure their safety they should not attend the scene of the emergency and should provide the AED to the member of the public and take a contact name and telephone number so that the equipment can be returned after use. 5.0 Procedures connected to this Policy The following list identifies the domains/linked documents that support this policy: Introduction - Levels of Response Guidance and Information Training Equipment Audit Local Protocols Algorithms Each domain may contain several documents and these will be updated quarterly with the full list being available on the intranet. 6.0 Links to Relevant Legislation Human Rights Act 1998 One of the main laws protecting human rights in the UK, it contains a list of 16 rights (called articles) which belong to all people in the UK, and outlines several ways that these rights should be protected. These rights are drawn from the European Convention on Human Rights, which were developed by the UK and others in the aftermath of World War II. The Human Rights Act may be used by every person resident in the United Kingdom regardless of whether or not they are a British citizen or a foreign national, a child or an adult, a prisoner or a member of the public. The Human Rights Act has two main aims, to promote a culture of human rights by making sure that basic human rights underpin the workings of government at the national and local level and enabling access to human rights here at home, instead of only being able to go to the European Court of Human Rights It does this by placing a legal duty on all public authorities, including NHS organisations and staff and mental health tribunals carrying out public functions, to respect and protect human rights in everything that they do. This means that public authorities have legal responsibilities for respecting, protecting and fulfilling human rights. This duty is important in everyday situations because it enables individuals to challenge poor treatment and to negotiate better solutions. Mental Capacity Act 2005 Mental Capacity Act 2005, covering England and Wales, provides a statutory framework for people who lack capacity to make decisions for themselves, or who have capacity and want to make preparations for a time when they may lack capacity Version 1.1 January 2017 8

in the future. The Act sets out who can take decisions, in which situations, and how they should go about this. In addition - in some cases, people lack the capacity to consent to particular treatment or care that is recognised by others as being in their best interests, or which will protect them from harm. Where this care might involve depriving adults at risk of their liberty in either a hospital or a care home, extra safeguards have been introduced in law Deprivation of Liberty Safeguards, to protect their rights and ensure that the care or treatment they receive is in their best interests. Children Act 1989 Children Act 1989 legislates for children in England and Wales. The intention of the legislation is that children's welfare and developmental needs are met, including the need to be protected from harm. The fundamental premise is that decisions are taken on the welfare principle i.e. that the court/adult s determination of best interests shall lie with the well-being of the child. 6.1 Links to Relevant National Standards NICE Clinical Guideline NG10 - Violence and Aggression 2015 This guideline has been developed to advise on the short-term management of violence and aggression in mental health, health and community settings in adults, children (aged 12 years or under) and young people (aged 13 to 17 years). This guideline updates and replaces NICE guideline CG25 (published February 2005). Resuscitation Council (UK): Resuscitation Guidelines 2015 The Resuscitation Council (UK) guidelines have been adapted from the 2015 ERC Guidelines and are tailored specifically to clinical practice in the UK. Resuscitation Council (UK): Quality Standards for Cardiopulmonary Resuscitation Practice and Training 2014 Healthcare organisations have an obligation to provide a high-quality resuscitation service, and to ensure that staff are trained and updated regularly and with appropriate frequency to a level of proficiency appropriate to each individual s expected role. This document provides quality standards for cardiopulmonary resuscitation practice and training in the following settings: 1. Acute care - mainly acute hospitals 2. Primary care - general practice (including out-of-hours services) 3. Primary dental care - Community care 4. Mental health - inpatient care The aim of these standards is to: 1. Improve care and outcomes for patients who are deteriorating, or suffer cardiorespiratory arrest in a healthcare setting. 2. Update existing quality standards with a particular emphasis on simplification to improve implementation. 3. Provide new standards for community hospital care and mental health inpatient care Version 1.1 January 2017 9

6.2 Links to other Key Policies Risk Management Policy The purpose of the Risk Management Policy is to provide an effective framework through which the Trust can safely and effectively manage risks. This policy does not cover individual patient clinical risk assessments which may be identified as part of a patients care plan. These individual clinical risk assessments for example, falls risk assessments, suicide risk assessments etc. will be conducted in line with the relevant clinical policy and process for the risk identified. Clinical Observation and Engagement Policy The purpose of this policy is to make clear the standards expected of clinical staff for the observation and engagement of patients, and to provide them with direction and guidance for making decisions about observation levels including reviews, carrying out observations, correct completion of documentation and their training requirements. Mental Health Act Policy The aim of the policy is to support staff in the effective implementation of the Mental Health Act, to ensure service users detained under the Act receive care and treatment lawfully and that they are able to exercise their rights at all times. Incident Reporting Policy The purpose of this policy is to make clear the system used for reporting incidents involving patients, staff and others undertaking activities on behalf of the Trust. Medical Devices Policy It is a requirement that all NHS Trusts have in place a comprehensive organisation wide policy on the deployment, monitoring and control of medical devices, as outlined in Managing Medical Devices: Guidance for Healthcare and Social Services Organisations 2014. This policy covers the provision for systems and process to ensure that whenever / wherever a device is used it is: Suitable for its intended purpose Properly understood by the professional and end user Maintained in a safe and reliable condition This policy and the related standard operating procedures include reference to three factors, which have a significant impact on device safety: Training of staff and end users including parents/carers of children or adults with complex health care needs who have a medical device(s) for use at home Maintenance of the medical device Decontamination of the medical device Death of an Adult Service User The purpose of this policy and procedure is to ensure that staff from the Black Country Partnership Foundation Trust handle the death of an adult service user in an appropriate manner including verification/confirmation of expected death by registered nurses. Version 1.1 January 2017 10

This policy and procedure applies to the death of all adult service users in Trust premises. It also applies to the death of adult service users in the community who are discovered by staff employed by the Trust. 6.3 References Department of Health Circular Resuscitation Policy HSC 2000/028 Gillick v West Norfolk and Wisbech Area Health Authority [1985] Decisions Relating to Cardiopulmonary Resuscitation (3rd edition). Guidance from the British Medical Association, the Resuscitation Council (UK), and the Royal College of Nursing (previously known as the "Joint Statement") October 2014 Rapid Response Report NPSA/2008/RRR010: Resuscitation in Mental Health and Learning Disability settings November 2008 Resuscitation Council (UK) Guidelines 2015 Resuscitation Council (UK) The Legal Status of those who Attempt Resuscitation. August 2010 Resuscitation Council (UK) Guidelines: Guidance for Safer Handling during Cardiopulmonary Resuscitation in Healthcare Settings. July 2015 Coventry and Warwickshire Unified Adult Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) policy (2013) Child and Young Person s Advance Care Plan Policy West Midlands Paediatric Palliative Care Network (2011) Version 1.1 January 2017 11

7.0 Roles and Responsibilities for this Policy Title Role Key Responsibilities All Clinical Staff Adherence - Identify patients at risk of deterioration and/ or cardio-pulmonary arrest and use the appropriate scoring mechanisms to assess this (e.g. NEWS) - Attend appropriate Resuscitation Training (see Training Documents) - Ensure that they receive appropriate training in the use of Resuscitation equipment - Have access to a protective face shield and be able to locate the nearest resuscitation equipment, ensuring that it is available at an incident where appropriate - Know how to contact the ILS responders and/or ambulance, to bring immediate life support skills and further equipment - Be aware of the dangers and safety considerations in relation to defibrillation - Be aware of the local resuscitation protocol for the area they are working in (see Local Protocols) - Use the structured ABCDE (Airway, Breathing, Circulation, Disability, Exposure) format to assess and treat the casualty appropriately following resuscitation guidelines - Assess and record the ABCDE assessment using the NEWS scoring system for deteriorating patients - Ensure that appropriate help is summoned as guided by the NEWS escalation plan for deteriorating patients - Ensure continuous reassessment of ABCDE and NEWS frequency of re- assessment will be directed by patient s condition and NEWS - If cardiac / respiratory arrest (no signs of life) are confirmed begin Basic Life Support (BLS) using Resuscitation Council (UK) guidelines according to the needs of the casualty and continue until directed by the ILS responders or Ambulance crew - Summon the ILS responders if appropriate, and the Ambulance Service, giving the exact location of the incident and indicating if appropriate any special circumstances (e.g. casualty is a child) - Ensure appropriate equipment is available for the incident - Co-operate and assist the ILS responders or Ambulance crew with the appropriate level of resuscitation, using the Resuscitation Council (UK) guidelines - Take account of any Do Not Attempt Resuscitation (DNACPR) orders - Refer to Decisions relating to Cardiopulmonary Resuscitation (3rd edition). Guidance from the British Medical Association, the Resuscitation Council (UK), and the Royal College of Nursing (previously known as the "Joint Statement") October 2014 - Support relatives, other patients, visitors and staff who are involved/witness resuscitation attempt - Ensure appropriate documentation is completed (e.g. Incident reporting form, Audit form, Care Records) - In the event of a serious clinical incident the Trust s SUI Policy and Reporting Procedures must be followed: - Resuscitation must be commenced even if the event is in suspicious circumstances - The person in charge of the unit must notify the on-call manager - The person in charge must inform the responsible consultant, as soon as is practicable - The next of kin of the deceased must be informed as soon as practicable - The police should be notified if appropriate Version 1.1 January 2017 12

Title Role Key Responsibilities Resuscitation and Management of Deteriorating Patient Non-clinical staff Adherence - Respond to all such situations immediately by dialling the appropriate emergency number for each site, stating the exact location of the incident and render assistance to the casualty according to their abilities - Immediately call a member of Clinical staff if an incident occurs in a clinical area and render assistance under the guidance of the clinical staff - Call a trained First Aider if an incident occurs away from a clinical area if available and/ or render assistance to the casualty according to their ability until a member of clinical staff attends ILS Responders Adherence - Receive appropriate training and annual updates (see Training Documents) - Ensure that they are up to date with current Resuscitation Council (UK) guidelines - Ensure appropriate cover and inform Senior Nurse/ On-Call Manager if they are unable to respond or carry the bleep during their allocated duty time - Arrive to all Medical Emergency Calls, (including resuscitation exercises organised by the Trust), within 3 minutes of the call being made, when on duty to respond - Remain with the casualty until the ambulance crew requests them to leave - Liaise with Senior Nurse/ On-Call Manager relating to any Medical Emergency bleep concerns and report any incidents/ near miss situations on an incident form - Ensure resuscitation equipment is being brought to the emergency - Respond with best speed to the site of the incident - Contact Switchboard/ Reception immediately, using the appropriate emergency number for the site, if they are unable to attend personally or have any queries relating to the call - Carry out the duties assigned to them and at the direction of the Resuscitation Team Leader, using Resuscitation Council (UK) Guidelines, and remain with the casualty until agreement with ambulance personnel over on going care - Following the handover to the paramedic crew (Using SBAR) the ambulance service will then take full responsibility for the resuscitation of the casualty - Immediately report any deficiencies or problems that may affect the efficiency or effectiveness of resuscitation to the Resuscitation Team Leader and Operational Manager - A summary of these deficiencies/problems will be submitted to the Trust Resuscitation sub-group - Report the incident in the casualty s care records (if the casualty is a patient) as well as the SBAR form - Take into account the guidelines for relatives witnessing resuscitation (see Guidance Notes) - Ensure a member of staff is sent to direct the ambulance personnel to the emergency as per local protocol Version 1.1 January 2017 13

Title Role Key Responsibilities All General/ Senior and Clinical Managers Reception / Switchboard Operators Resuscitation and Management of Deteriorating Patient Operational - Ensure that a risk assessment is undertaken to identify the level of response for their area, which will be agreed through the Resuscitation Lead and Group and clearly documented in the associated document (See Levels of Response) - Ensure that any changes to the location/ level of response/ requirements are reported to the Resuscitation Sub-group who will review and update Trust areas levels of response on a quarterly basis - Identify patients at risk of deterioration and/ or cardio-pulmonary arrest and use the appropriate scoring mechanisms to assess this (e.g. NEWS) - Ensure that the recommended equipment is available and operational and that it is restocked immediately following an incident (see Equipment List) - Ensure that the agreed level of resuscitation equipment is available within 3 minutes from collapse of the casualty and is brought to the emergency within this timeframe - Ensure that ILS responders will have access to the additional equipment requirements within 3 minutes - Ensure that all clinical staff working outside of the Trust premises are provided with, and carry at all times, a mouth to mask device or protective face shield - Ensure that the equipment is checked daily and after use, using the standard checking document (see Equipment List) - Liaise with medical devices to ensure that planned preventative maintenance is carried out on resuscitation equipment - Ensure that all equipment faults/ problems are acted upon immediately and reported to the appropriate departments, including completion of an incident reporting form - Ensure that all appropriate staff receives appropriate training (see Training Documents) - Ensure that all staff are aware of the Management of Deteriorating Patient and Resuscitation Policy and Procedures. - Ensure that in service user areas that have restricted access, the staff responding to the emergency and Ambulance crew can enter, at best speed Operational - Ensure that all Reception/ Switchboard staff are aware of the procedure for dealing with all Medical Emergency Calls - Ensure test calls are made to the emergency bleep holders at a pre-arranged time - Ensure that all responders that do not respond within 5 minutes of the test call being made are contacted again immediately (repeat test call) - If an responder cannot be contacted following a test call, use the Tannoy or telephone system to try to establish contact and an incident reporting form to be completed stating it as a near miss situation - Keep a log of all Medical Emergency calls (including test calls) made - Provide a copy of the logged Medical Emergency calls for the Associate Director of Risk and Resuscitation Service as required - Repeat back the incident and exact location to the caller - Activate the emergency bleeps (if appropriate) and call an ambulance as per local protocol identifying exact location and incident - Connect Ambulance Control to the area dealing with the casualty, who will advise Ambulance Control if the incident is Urgent or an Emergency (see Guidance Notes) - Contact other appropriate personnel as requested - Ensure appropriate documentation is completed (e.g. Incident reporting form, Medical Emergency Audit form, Care Records etc.) Version 1.1 January 2017 14

Title Role Key Responsibilities Resuscitation and Management of Deteriorating Patient Consultants Implementation - Take a lead role in implementing the Do Not Attempt Resuscitation (DNACPR) Policy - Refer to Decisions relating to Cardiopulmonary Resuscitation (3rd edition). Guidance from the British Medical Association, the Resuscitation Council (UK), and the Royal College of Nursing (previously known as the "Joint Statement") October 2014 - Ensure that all appropriate grades of Medical Staff in their team have attended training appropriate to their needs (see Training Documents) - Support and advise the staff responding to emergencies as appropriate - Ensure that all Medical staff in their team is made aware of the Management of Deteriorating Patient and Resuscitation Policy and Procedures Learning and Development Team Resuscitation Sub- Group of Professional Advisory Group (PAG) Executive Director of Nursing, AHPs and Training - Provide the Trust with adequate training sessions to meet the needs of the service - Ensure that the Trust is complying with the statutory and mandatory requirements that are required for the Trust and its employees Responsible - Ensure that policy and practice within the Trust conforms to national guidance and best practice - Report on a quarterly basis to the Professional Advisory Group (PAG) Executive Lead - Lead responsibility for the implementation and monitoring of the Management of Deteriorating Patient and Resuscitation Policy Governance Chief Executive Assurance - Overall responsibility for the Trust s Management of Deteriorating Patient and Resuscitation Policy with operational responsibility delegated to the Director of Nursing and Quality Version 1.1 January 2017 15

8.0 Training What aspect(s) of this policy will require staff training? Immediate Life Support (ILS) Which staff groups require this training? Registered Nurses/ Inpatient staff Is this training covered in the Trust s Mandatory and Risk Management Training Needs Analysis document? Yes If no, how will the training be delivered? Who will deliver the training? External training provider How often will staff require training Annually Who will ensure and monitor that staff have this training? Workforce Development Group Basic Life Support (BLS) Non-Clinical Staff Yes Learning and Development Team Annually Workforce Development Group ELS Registered Nurses OP/ Inpatient HCA/ Other Clinical Staff This should be in the mandatory training External training provider Annually Workforce Development Group A training matrix has been completed to identify the level of mandatory resuscitation training required for all staff groups (see Training Documents) All relevant staff as identified in the physical health observations policy should be competent in assessing a client s physical health observations and relating these findings [where necessary] to the national early warning score system and initiating the appropriate respo nse as directed by the escalation plan All clinical staff must be trained in the structured ABCDE assessment process 9.0 Equality Impact Assessment Black Country Partnership NHS Foundation Trust is committed to ensuring that the way we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group. The Equality Impact Assessment for this policy has been completed and is readily available on the Intranet. If you require this in a different fo rmat e.g. larger print, Braille, different languages or audio tape, please contact the Equality & Diversity Team on Ext. 8067 or email EqualityImpact.assessment@bcpft.nhs.uk Version 1.1 January 2017 16

10.0 Data Protection and Freedom of Information This statement reflects legal requirements incorporated within the Data Protection Act and Freedom of Information Act that apply to staff who work within the public sector. All staff have a responsibility to ensure that they do not disclose information about the Trust s a ctivities in respect of service users in its care to unauthorised individuals. This responsibility applies whether you are currently employed or after your employment ends and in certain aspects of your personal life e.g. use of social networking sites etc. The Trust seeks to ensure a high level of transparency in all its business activities but reserves the right not to disclose information where relevant legislation applies. 11.0 Monitoring this Policy is Working in Practice What key elements will be monitored? (measurable policy objectives) Where described in policy? How will they be monitored? (method + sample size) Who will undertake this monitoring? How Frequently? Group/Committee that will receive and review results Group/Committee to ensure actions are completed Evidence this has happened Initiation of resuscitation, including the system for summoning help 4.0 Process Audit - Simulation and reviews Deputy Director of Nursing Quarterly Resuscitation Sub- Group of Professional Advisory Group (PAG) Professional Advisory Group Minutes of meetings/ Action plan signed off Do not attempt resuscitation orders (DNACPR) 4.0 Process Audit Deputy Director of Nursing Quarterly Resuscitation Sub- Group of Professional Advisory Group (PAG) Professional Advisory Group Minutes of meetings/ Action plan signed off Process for ensuring the continual availability of resuscitation equipment 4.0 Process Audit Deputy Director of Nursing Quarterly Resuscitation Sub- Group of Professional Advisory Group (PAG) Professional Advisory Group Minutes of meetings/ Action plan signed off Management of Medical Emergencies 4.0 Process Audit - Simulation and reviews Deputy Director of Nursing Quarterly Resuscitation Sub- Group of Professional Advisory Group (PAG) Professional Advisory Group Minutes of meetings/ Action plan signed off Version 1.1 January 2017 17

Policy Details Title of Policy Unique Identifier for this policy State if policy is New or Revised Management of a Deteriorating Patient and Resuscitation Policy BCPFT-PH-POL-02 New Previous Policy Title where applicable Policy Category Clinical, HR, H&S, Infection Control etc. Executive Director whose portfolio this policy comes under Policy Lead/Author Job titles only Committee/Group responsible for the approval of this policy n/a Physical Health Executive Director of Nursing, AHPs and Governance Physical Health Matron Month/year consultation process completed * November 2015 Month/year policy approved January 2017 Month/year policy ratified and issued May 2017 Next review date August 2019 Professional Advisory Group (PAG) Implementation Plan completed * Equality Impact Assessment completed * Previous version(s) archived * Disclosure status Key Words for this policy Yes Yes Yes B can be disclosed to patients and the public Recognition of patients at risk, NEWS, Basic life support, Immediate life support, Cardiopulmonary resuscitation, Do not attempt resuscitation, Paediatrics, Debriefing staff and patients, Informing next of Kin * For more information on the consultation process, implementation plan, equality impact assessment, or archiving arrangements, please contact Corporate Governance Review and Amendment History Version Date 1.0 Aug 2016 1.1 Jan 2017 Details of Change New policy for BCPFT; combining existing Resuscitation Policy and Management of a Deteriorating Patient Policy into one document Minor amendment: Additional information added regarding the provision of emergency equipment when requested by members of the general public Version 1.1 January 2017 18