BIRMINGHAM AND SOLIHULL MENTAL HEALTH NHS TRUST REPORT TO THE TRUST BOARD. TO BE HELD ON 21 June 2006

BIRMINGHAM AND SOLIHULL MENTAL HEALTH NHS TRUST REPORT TO THE TRUST BOARD TO BE HELD ON 21 June 2006 Item: To be Reported By: Clinical Governance Committee Meeting: 6 June 2006 Peter Marquis, Chair, Clinical Governance Committee Author: Peter Hughes, Head of Healthcare Standards PURPOSE OF THE REPORT: To report in summary on the Clinical Governance Committee meeting held on 6 June 2006. KEY POINTS: The key points from the June meeting are: The meeting was chaired by Ros Alstead and due to the conflicts of duties on other members of Trust Board the meeting was not qourate and therefore the meeting proceeded informally. For this reason the Trust Board is asked to AGREE the proposed Resuscitation policy (appendix 2). Mental Health & Deafness A presentation providing details of the Deaf Mental Health Charter was given by the Deaf Service. The meeting was reminded that in order to comply with the Disability Discrimination Act 2005, local authorities and health bodies are required to produce a Disability Equality scheme and action plan by December 2006. The committee was asked to adopt the charter and approve the action plan. The action plan was agreed in principle for further details on implementation to be reported back at a future meeting. Reports from Clinical Governance Sub-Committees The meeting received reports from the Clinical Governance sub committees: Risk Management The Trust has been reassessed as compliant with CNST standards level 1. A report provided by the assessor and action plan covering the period 2006/07 will be submitted to the CGC in July 2006. Patient Focus & Experience Mark Hillier was congratulated on his recent appointment to Head of Patient & Public Involvement. Provisional results from the Patient Survey were discussed. It was noted that positive progress has been made in a number of areas from the previous year. A detailed action plan in response to the survey will be developed. 1

Clinical Practice The committee had reviewed NICE guidance TA97 for Computerised Cognitive Behavioural therapy and confirmed that the guidance did not apply to the Trust at present. The committee also agreed to prioritise the agreement of the various mental health team operational policies which were under development and these will be presented to the committee in the next 2 months. HRM & Development IWL practice plus accreditation has now been confirmed. The Staff Survey results had been discussed and work was underway to co-ordinate an action plan in response. Standards for Better Health Update A summary variance report on issues relating to the Healthcare standards was presented. This is attached (Appendix 1) for review by the Trust Board. The meeting was made aware of the Healthcare Commission s intention to monitor four of the developmental standards as part of the Healthcare Standards declaration process for 2006 / 07. The committee agreed to further review arrangements for the co-ordination of Public Health issues as this is also included as a developmental standard for monitoring this year. Policies for Approval Resuscitation Policy The committee endorsed the policy attached (Appendix 2) which is presented to the Trust Board for agreement. Recognition of Service (Retirement Gifts) The meeting noted and approved the protocol. Use of Information Technology The report, detailing IT usage within the Trust, was reviewed by the committee. Concerns were expressed at the amount of staff not using the intranet to access up-todate information. HMP CG & RM COMMITTEE NOTES/EXCEPTION REPORT The report was noted by the committee. DELIVERING THE LDP 2006/07 IMPACT ON SERVICES The meeting was advised of the proposed temporary closure of the Ashcroft assessment ward from the end of July 2006 due to unprecedented staff pressures and the temporary closure of the Edendale respite unit due to under occupancy. IMPLICATIONS: There are no major legal implications as a result of the decisions of the Legal: committee. Training: Some training requirements have been identified in relation to the roll out of the Resuscitation Policy The funding for the Recognition of Service (Retirement Gifts) protocol has been Financial: reviewed and approved by the Funding Committee. The potential cost implications associated with the Deaf Mental Health Charter are not yet available but any major expenditure Would be identified as part of 2

the action plan and be then subject to appropriate business case approval. Other: RECOMMENDATION(S): To note the report. To note the Healthcare Standards variance report (appendix 1) To agree the Resuscitation policy (appendix 2) 3

STANDARDS FOR BETTER HEALTH QUARTERLY EXCEPTION / VARIANCE REPORT APPENDIX 1 This report sets out any indications of variation of exceptional issues which have occurred over the past quarter. Reporting of these issues does not indicate non compliance but should be recognised by the Board as part of its understanding of the assurance process. SOURC E ISSUE SfBH ref Potential impact on compliance Actions to be taken Assessment / Director responsible. Staff Survey Areas of lowest 20% compared to other Trusts: % staff receiving training or development in previous 12 months % staff having health and safety training in previous 12 months % staff witnessing potentially harmful errors, near misses or incidents in previous 12 months % staff experiencing harassment, bullying or abuse from patients/relatives in previous 12 months % staff experiencing harassment, bullying or abuse from staff in previous 12 months 8b, 11b, 11c, 20a Whether sufficient systems are in place for development review and whether these are being acted upon. 1a, 11b This reflects on the requirement of the Trust in relation to its Health & Safety responsibilities. 1a, 20a A high number of harmful errors may suggest that risk management arrangements are 20a 7b,7e, 8a not effective in reducing risks. Whether sufficient arrangements are in place to support staff. This reflects extremely poorly on the Trusts ability to demonstrate that it has adequate systems in place in relation to whistle Requires further review. Continue revised provision of mandatory training. Ensure staff are aware that this is health & safety training. Requires further review. Consider benchmarking with other similar trusts Requires further review Requires further review in relation to incidents and whistle blowing / HR issues Report presented to Trust Board in May and IWL steering group to develop action plan. It is possible that the difficulties relating to mandatory training identified below have impacted on this. Declaration process identified that H&S training had not been provided consistently during the year. However additional training was provided at the end of the year (after the survey was issued). There may also be an issue that the training is not explicitly called health & safety training This could be an impact of good incident reporting however this will require further understanding of data and comparisons with other Trusts. 4

SHA report on 05 / 06 declarati on SHA reported in its commentary to the Healthcare Standards declaration that it felt the Trust had little capacity or infrastructure to support patient / carer involvement. blowing, openness and respect for human rights. 17 This could reflect on the Trusts ability to comply with the standard to take into account the views of patients & carers. To be discussed with the SHA to seek clarification. It is difficult to understand how this assessment has been made. The Trust has a reasonable infrastructure for patient / carer involvement particularly reflected in User Voice and PALS. 5

Birmingham & Solihull Mental Health NHS Trust Resuscitation Policy To be read in conjunction with Trust policies, procedures and protocols relating to the following: - Unexpected Death Serious Untoward Incidents Infection Control Staff Support and De-Briefing Rapid Tranquillisation Policy Birmingham & Solihull Mental Health Trust Resuscitation Committee Date of Approval: April 2006 Clinical Governance Committee Date of Approval: June 2006 Person responsible for policy review: Chair of Resuscitation Committee Date of Review: May 2007 6

SECTIONS 1. Policy Statement 2. Preparation for Resuscitation 3. Resuscitation Procedures 4. Do Not Attempt Resuscitation (DNAR) 5. Special Circumstances 6. Debriefing 7. Resuscitation Committee APPENDICES 1. Resuscitation Training Matrix 1a. Description of course content 1b Assessment Sheet for Basic Life support 1c Assessment Sheet for Hospital Life Support 1d Assessment Sheet for Paediatric Life Support 1e Assessment Sheet for Resuscitation Council Assessment Sheet for Airway 1f Assessment Sheet for Resuscitation Council Assessment Sheet for Defib 2. Resuscitation Equipment Lists 3. Equipment list Checking Forms 4. Medical Emergency Team Composition and calling criteria 5. Guidelines for Relatives Witnessing Resuscitation 6. Guidance Sheet for Informing Ambulance Control 7. Local Protocols 8. Resuscitation Status Form 9. Trust localities/response Supplemental Information 1. Joint Statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing 2. Department of Health Circular Resuscitation Policy HSC 2000/028 References 1. Resuscitation Council (UK): Decisions Relating To Cardiopulmonary Resuscitation A Joint Statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing February 2001 2. Resuscitation Council (UK) Guidelines 2005 3. Resuscitation Council (UK) Guidelines: The legal status of those who attempt Resuscitation October 2000 4. Resuscitation Council (UK) Guidelines: Depth of chest compressions July 2001 7

5. Resuscitation Council (UK) Guidelines: Guidance for safer handling during resuscitation in hospitals July 2001 6. Resuscitation Council (UK): CPR Guidance for clinical practice and training in hospitals February 2000 (Appendix revised June 2001) 7. Department of Health Circular Resuscitation Policy HSC 2000/028 8. The Human Rights Act (1998) 9. The Children s Act (1989) 10. University Hospital of Birmingham Trust: Resuscitation and Do Not Attempt Resuscitation Policies 2002 14. Resuscitation Council (UK): Competencies in adult Cardiopulmonary Resuscitation and the use of an Automated External Defibrillator, May 2002, Updated July 2002, April 2003 15. South London and Maudsley NHS Trust: Adult Resuscitation Policy, September 2001 16. Gillick v West Norfolk and Wisbech Area Health Authority [1985] Important Notice: Trust units at Solihull Hospital are subject to resuscitation policies and procedures of Solihull hospital and Trust Resuscitation policies, procedures and protocols 8

1.1 Policy Statement 1.1.1. It is the Policy of Birmingham and Solihull Mental Health Trust that all Clinical Nursing and Medical Staff and other identified Clinical Professional Staff have the knowledge, skills, training and equipment to carry out resuscitation 1.1.2 Resuscitation can prevent irreversible cerebral damage or death due to anoxia / hypoxia by restoring effective ventilation and circulation 1.1.3 Resuscitation is required if there are 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 1.1.4 It must be recognised that not all resuscitation attempts are successful despite the best efforts, and it is important that emergency medical aid is sought immediately to improve the possibility of a successful outcome 1.1.5 If there is any doubt about the resuscitation status of a patient then clinical staff should attempt resuscitation as outlined in the procedure 1.1.6 The Trust will take all reasonable steps to provide the first aid response of basic life support in all instances and refer for subsequent specialist treatment and care 1.2 Aim of Policy 1.2.1 To adhere to all the recommendations made by the Resuscitation Council (UK 2005) with regard to matters concerning resuscitation. As part of the Trusts duty of care to patients 1.2.2 To ensure 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 clinical Trust staff, will receive an appropriate response which will maximise their chances of survival 1.3 Grading of Response 1.3.1 The Birmingham and Solihull Mental Health Trust delivers care in a wide variety of settings. As a result of this variety it is not possible for the Trust to offer the same resuscitation response across all of its services. 1.3.2 Therefore the purposes of this policy is to identify / document the level of response for each area (appendix 9). These levels will be as follows: First Aid The staff in this area will provide basic life support (BLS) with the use of a pocket mask Hospital Life Support (HLS) The staff in this area will provide basic life support with the use of all basic airway adjuncts (see equipment list 2) and if an automated external defibrillator (AED) became available, this would also be included. Immediate Life Support (ILS) Either the staff in this area or a responding Medical Emergency Team (MET) would provide HLS (as detailed above) including AED. Depending on the team responding this level of response may also include drug administration and laryngeal mask airway insertion. 9

2. Preparation for resuscitation 2.1 It is the responsibility of the Ward/ Resource Centre/Community Unit / Residential Unit Manager to ensure that: 2.1.1 The recommended equipment (appendix 2 and 9) is available and operational and that it is restocked immediately following an incident 2.1.2 Area s that have a MET response must have access to the equipment list 1 or 1a (appendix 2 and 9) 2.1.3 All Community Psychiatric Nurses must be provided with and carry at all times a mouth to mask device 2.1.4 Ensure that the equipment is checked daily and after an incident using the standard checking document (appendix 3) 2.1.5 Liaise with medical engineering to ensure that planned preventative maintenance is carried out on resuscitation equipment 2.1.6 Ensure that all equipment faults / problems are acted upon immediately and reported to the appropriate departments, including completion of an incident reporting form (IRIS) 2.1.7 Ensure that all appropriate staff within the Ward/Resource Centre/ Community Unit/Residential Unit receive appropriate training (appendix 1) 2.1.8 Ensure that all staff are made aware of the Resuscitation Policy and procedures 2.1.9 Ensure that clinical Areas where patients are present, that have restricted access, must ensure that the Medical Emergency Team or Ambulance crew can enter, at best speed. 2.2 It is the responsibility of all Clinical Medical, Nursing and identified Allied Professions (AHP) staff to: 2.2.1 Attend appropriate Resuscitation Training 2.2.2 Ensure that they receive appropriate training in the use of Resuscitation equipment 2.2.3 Be able to locate the nearest resuscitation equipment and ensure that it is available at an incident 2.2.4 Know how to contact the Medical Emergency Team and / or ambulance, to bring immediate life support equipment. 2.2.5 Be aware of the dangers and safety considerations in relation to defibrillation 2.3 It is the responsibility of each Medical Consultant to: 2.3.1 Take a lead role in implementing the Do Not Attempt Resuscitation (DNAR) Policy (section 4) 10

2.3.2 Ensure that all appropriate grades of Medical Staff in their team have attended training appropriate to their needs (appendix 1) 2.3.3 Support and advise the Medical Emergency Team as appropriate 2.3.4 Ensure that all Medical staff in their team are made aware of the Resuscitation Policy and procedures 2.4 It is the responsibility of each Medical Emergency Team Member (appendix 4) to: 2.4.1 Receive appropriate training and annual updates (appendix 1) 2.4.2 Ensure that they up to date with current Resuscitation Council (UK) guidelines 2.4.3 Carry the Medical Emergency Bleep during the period of duty with the Medical Emergency Team 2.4.4 Ensure appropriate cover and inform Reception/Switchboard and Senior Clinical Manager / Duty Nurse if they are unable to carry the bleep during their allocated duty time 2.4.5 Arrive to all Medical Emergency Calls, (including resuscitation exercises organised by the Trust), within 3 minutes of the call being made, when on duty with the Medical Emergency Team. Then remain with the casualty until the ambulance crew request them to leave 2.4.6 Liaise with Reception/Switchboard and Senior Clinical Manager/ Duty Nurse relating to any Medical Emergency bleep concerns and report any incidents / near miss situations on an incident form (IRIS) 2.5 It is the responsibility of the Reception/Switchboard Supervisor to: 2.5.1 Ensure that all Reception/Switchboard staff are aware of the procedure for dealing with Medical Emergency Calls 2.5.2 Ensure test calls are made to the Medical Emergency Team members at a prearranged time 2.5.3 Ensure that all Medical Emergency Team members that do not respond within 5 minutes of the test call being made are contacted again immediately (repeat test call) 2.5.4 If a member of the team cannot be contacted following a test call to use the Tannoy or telephone system to try to establish contact and an incident reporting form (IRIS) to be completed stating it as a near miss situation 2.5.5 Keep a log of all Medical Emergency calls (including test calls) made 2.5.6 Provide a copy of the logged Medical Emergency calls for the Associate Director of Risk and UHB Resuscitation Service as required. 11

3. Resuscitation Procedures 3.1 On confirmation of a Respiratory/Cardio-respiratory arrest all Clinical staff will: 3.1.1 Begin Basic Life Support (BLS) using Resuscitation Council (UK) guidelines according to the needs of the casualty and continue until HLS equipment available and / or directed by the responding Medical Emergency Team or Ambulance crew. 3.1.2 Summon the Medical Emergency Team, 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) 3.1.3 Ensure appropriate equipment (appendix 2) is available for the incident 3.1.4 Co-operate and assist the Medical Emergency Team or Ambulance crew with Immediate Life Support (ILS) as appropriate using the Resuscitation Council (UK) guidelines 3.1.5 Take account of any Do Not Attempt Resuscitation (DNAR) orders 3.1.6 Support relatives, other patients, visitors and staff who are involved / witness a resuscitation attempt 3.1.7 Ensure appropriate documentation is completed (e.g. Incident reporting form (IRIS), Medical Emergency Audit form, Clinical Notes etc.) 3.1.8 In the event of a death, the person in charge of the ward/unit should notify the service manager/modern matron 3.1.9 In the event of a serious clinical incident the Trusts on call Director must be contacted immediately and the Trust s Risk management department by the next working day 3.1.10 In the event of a death the person in charge must inform the responsible Medical Officer (RMO), as soon as is practicable 3.1.11 In the event of a death the deceased next of kin must be informed as soon as practicable 3.2 Non Clinical Staff who suspect resuscitation may be required will: 3.2.1 Respond to all such situations immediately by dialing the appropriate emergency number for each site, stating the exact location of the incident 3.2.2 If an incident occurs in a Clinical area they will immediately call a member of Clinical staff and render assistance at the guidance of the Clinical staff 3.2.3 If an incident occurs away from a clinical area they will also call a trained First Aider, if available, and/or render assistance to the casualty according to their ability until Clinical staff attend 3.3 On receiving a Medical emergency call the Reception/Switchboard will: 3.3.1 Repeat back the incident and exact location to the caller 12

3.3.2 Activate the Medical Emergency Team bleeps or call an ambulance as per local protocol, identifying exact location and incident 3.3.3 Contact 999 and request an emergency ambulance. Also ensure that the ambulance can gain access to the building and location (refer to local Protocol) 3.3.4 Reception/ Switchboard will then connect Ambulance Control to the Medical Emergency Team or clinical area who will advise Ambulance Control if the incident is Urgent or an Emergency (appendix 6) 3.3.5 Contact other appropriate personnel as requested 3.3.6 Complete appropriate documentation (IRIS and AUDIT) and forward to Risk Management and Resuscitation Service 3.4 On hearing the Medical Emergency Bleep it is the responsibility of each Medical Emergency Team member to: 3.4.1 Ensure resuscitation equipment is being taken to the emergency 3.4.2 Respond with best speed to the site of the incident 3.4.3 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 3.4.4 Carry out the duties assigned to them and at the direction of the Team Leader, using Resuscitation Council (UK) Guidelines, and remain with the casualty until agreement with ambulance personnel over ongoing care. 3.4.5 Report immediately any deficiencies or problems that may effect the efficiency or effectiveness of resuscitation to the Team Leader, Lead Nurse, Resuscitation Service, Consultant and/or Associate Director of Risk 3.4.6 A summary of these deficiencies/problems will be submitted to the Trust Resuscitation Committee 3.4.7 The Team Leader will report the incident in the casualty s clinical notes (if the casualty is a patient) as well as the Medical Emergency Audit form 3.4.8 Take into account the guidelines for relatives witnessing resuscitation (appendix 5) 3.4.9 Ensure a member of staff is sent to direct the ambulance personnel to the emergency as per local protocol 4. Do Not Attempt Resuscitation Policy (DNAR) 4.1.1 A Do Not Attempt Resuscitation (DNAR) decision applies solely to Cardiopulmonary Resuscitation (CPR). CPR relates to basic, hospital and immediate life support. All other treatment and care should be continued and not be influenced by the DNAR decision 13

4.1.2 This section of the policy is based upon recommendations from the British Medical Association, Royal College of Nursing, Resuscitation Council (UK), Articles 2 and 6 of the Human Rights Act (1998) and the Health Service Circular issued by the Department of Health (2000) 4.1.3 The Trust Board accepts these statements and how relevant it is to Clinical staff and this DNAR section of the Resuscitation Policy has been developed in the best interest of both Patients and Staff. 4.1.4 Cardiopulmonary Resuscitation (CPR) can theoretically be used on every individual prior to death. It is essential to identify Patients for whom CPR is inappropriate 4.1.5 Unless there is a DO NOT ATTEMPT RESUSCITATION (DNAR) order written in the Patient s Clinical Notes, CPR is mandatory on any person who suffers a cardiac and/or respiratory arrest 4.2 Considerations 4.2.1 A DNAR decision must be taken in the best interests of the Patient, which should include likely clinical outcome and the Patients known, or ascertainable, wishes. Consideration should therefore be given to the following: o Where the Patients condition indicates that effective CPR is unlikely to be successful o Where CPR is not in accord with the recorded ( Living Will ), sustained wishes of the Patient who is mentally competent or deemed mentally competent in respect to this decision (if there is any doubt a Second opinion from the Mental Health Commission or Judicial review should be sought) o Where CPR is not in accord with a valid applicable advance directive (i.e. a competent Patient who is fully informed of their condition and circumstances has a legal right to refuse CPR if they so desire). Unless a Patients legal representative has prepared any advance directive ( Living Will ), advice should be sought from the Trusts Solicitors o Where resuscitation is likely to be followed a quality of life that would not be in the best interests of the Patient to sustain 4.3 Determination of Resuscitation Status 4.3.1 Consideration should be given and appropriate personnel involved for patients who do not speak English as a first language or have Hearing and/or Speech disability 4.3.2 Establishment of a DNAR status is the responsibility of the Consultant in Charge (or nominated Consultant in circumstances where the Consultant in Charge is on leave) of the Clinical Care of the Patient and only applies to patients in a hospital or residential setting 4.3.3 This responsibility may be devolved to individuals occupying a Specialist Registrar role or equivalent but the decision must be discussed and agreed with the appropriate Consultant at the earliest opportunity, but within 24 hours of the decision being made 4.3.4 Where a DNAR decision has been made, then the DNAR decision must be reviewed regularly, (no greater than 7 days unless the reason for longer is specified or more regularly if the condition of the patient fluctuates) with a review date and time that is documented and signed (Appendix 8) 14

4.3.5 This is to be placed in a position in the Clinical notes where it is easily and visibly recognizable and accessible 4.3.6 If a DNAR decision is made and the patient either subsequently goes on leave for more than 7 days or is discharged and re-admitted after 7 days the DNAR decision is no longer valid and will have to be considered again 4.3.7 The decision relating to the resuscitation status of patients who are mentally competent (or deemed mentally competent in regards to this) must be the result of a sensitive exploration of their wishes regarding resuscitation. 4.3.8 This should be carried out by the responsible doctor concerned, with a full record of any such discussions and decisions documented, signed, timed and dated in the patient s Clinical notes. (Appendix 8) 4.3.9 If however the Patient does not agree with the decision not to attempt resuscitation, a second medical opinion from another Consultant Psychiatrist must be sought immediately 4.3.10 Resuscitation should be attempted if necessary whilst awaiting the second opinion. If the patient continues to disagree with the second medical opinion then legal advice should be sought from the Trust Solicitors. Resuscitation should be continued until the Trust Legal Services advises to the contrary 4.3.10 Other Health Care Workers involved in the care of the Patient should be involved in the discussions formulating the final decision on the Patients resuscitation status 4.3.11 If the patient does not have the capacity to make decisions the doctor must act in the best interests of the Patient 4.3.12 In such circumstances it is good practice to involve the Next of Kin, carers, close relatives, friends or individuals with Loco Parentis status, in assisting them to form a decision, although it is recognised that such discussions must be conducted with due regard to patient confidentiality 4.3.13 It should, however, be remembered that the Next of Kin or others have no legal right to offer consent or refuse treatment on behalf of a Patient 4.3.14 If a Next of Kin, Carer, close relative or individual with Loco Parentis responsibility disagrees with the decision then a second opinion from another Consultant Psychiatrist must be sought. Resuscitation should be attempted if necessary whilst awaiting the second opinion. If the Next of Kin, Carer etc. continues to disagree then legal advice should be sought from the Trust solicitors. Resuscitation should be continued until the Trust Legal Services advises to the contrary 4.3.15 The DNAR order and any reviews should be written prominently in the Clinical notes by the doctor taking the decision (Appendix 8). It should clearly be stated that the patient is not for cardiopulmonary resuscitation, together with a record of the date, time, clinical justification, review date, those consulted with a record of their views, and the Patients views, if applicable. The entry in the Clinical notes must be clearly signed and dated 15

4.4 Minors (under 18) 4.4.1 In all circumstances, the minor s best interests must be viewed as paramount and if at all possible the minor s view must be obtained BSMHT Resuscitation Policy 4.4.2 There is no age limit to when a minor can be involved in the decision making relating to their resuscitation status (Gillick competencies 1985), however a minor is often viewed as being competent from about the age of 13 onwards 4.4.3 If a minor is competent to be involved with the decision-making and their views differ from those with parental responsibility legal advice from the Trust solicitors should be sought in all circumstances 4.5 Audit 4.5.1 The resuscitation committee will be responsible for co-ordinating the review and audit of this policy. 5. Special Circumstances in Resuscitation 5.1 The Resuscitation Policy must be adhered to at all times however some circumstances may require further consideration 5.2 Paediatrics 5.2.1 The Resuscitation Council (UK) recognises 3 subgroups amongst children: o Neonates in the first few days after birth o Infants from neonate to 1 year o Child from 1 year puberty 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 5.2.2 All Clinical staff working in areas that manage paediatric patients will undertake appropriate paediatric resuscitation training 5.2.3 All Clinical areas with paediatric patients will have paediatric size oropharyngeal airways (00, 0, 1, 2), a child bag valve mask, child size yankaeur sucker and a paediatric high concentration oxygen mask. 5.2.4 All Clinical staff working in areas that manage paediatric patients will commence paediatric basic hospital life support 5.2.5 The responding Medical Emergency team (if available) will assist with resuscitation to the level of their ability and resuscitation equipment available until the ambulance arrives. 5.2.6 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. 16

5.2.7 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 5.3 Other Considerations 5.3.1 The Medical Emergency Team 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.) 5.3.2 If a patient s condition is of urgent concern to the staff present, the emergency number can be used to call the Medical Emergency Team and the patient s own medical team 5.3.3 Non-Clinical staff, including switchboard/reception staff are not expected to diagnose respiratory / cardiopulmonary arrest and therefore emergency calls that are made with an undefined diagnosis will be put out to the Medical Emergency Team and / or Ambulance call so that they can respond with best speed. 5.3.4 A clinical review maybe initiated following a medical emergency, this is to be commissioned by the Clinical Director or Service Director 6. Debriefing 6.1 Staff / patients 6.1.1 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 constructively their feelings and thoughts in a constructive way 6.1.2 A nominated member of staff, who has the appropriate knowledge and skills relating to resuscitation and debriefing wherever possible, will facilitate all debriefings 6.1.3 Following a Medical Emergency, all Staff participating or witnessing the resuscitation will be offered an opportunity to debrief 6.1.4 Debriefing of a Medical Emergency should occur wherever possible within 7 days of the medical emergency incident 6.1.5 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 6.2 Next of Kin 6.2.1 Staff will inform the Next of Kin of the incident, outcome and location of the person resuscitated if this is a service user 6.2.2 Relatives witnessing resuscitation being undertaken by staff on Trust premises will be informed and supported as per guidelines (appendix 5) 17

6.2.3 The service manager will inform the Next of Kin of the incident, outcome and location of the person resuscitated if this is a staff member 6.2.4 The service 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 7. Trust Resuscitation Committee 7.1 Aim of the Committee 7.1.2 To promote high standards and quality of resuscitation within Birmingham and Solihull Mental Health Trust 7.1.3 To achieve a robust, interrelated multidisciplinary approach to service, training, education and development of resuscitation 7.2 Objectives of the Committee 7.2.1 To advise and seek to implement current guidelines and protocols in accordance with the recommendations of the Resuscitation Council (UK), European Resuscitation Council, Royal Colleges (RCS, RCN) and other international and national professional bodies (BMA, NMC) 7.2.2 To develop a Strategic Viewpoint to oversee the implementation of a Trust-wide Action Plan for Resuscitation and Medical Emergencies 7.2.3 To regularly review and revise all Trust-wide resuscitation policies, procedures and protocols in line with changes in national, local guidelines and lessons learnt from reviews of resuscitation or medical emergency incidents 7.2.4 To promote a broader approach to resuscitation training and education through development of specialised multidisciplinary courses 7.2.3 To be able to invest in resuscitation courses to meet the needs of the Trust 7.2.4 To regularly review the practice of resuscitation within the Trust, to advise and recommend changes to meet standards of good practice 7.2.5 To commission and develop audit of resuscitation and records attaining to resuscitation within the trust and act on the information provided 7.2.6 Provide reports and information for relevant Trust Clinical Governance Committees and the Trust Board 7.2.7 The committee will report to the Risk Management Committee. 7.3 Trust Resuscitation Committee Membership 7.3.1 Essential: Director of Nursing, Consultant Psychiatrist Representative, Identified Trust Lead for resuscitation, Associate Director of Risk, Director of Organisation and Workforce, University Hospital Birmingham Resuscitation Service Manager 18

7.3.2 Recommended: Identified Lead from each Directorate/Locality,representatives from Nursing, Allied Health Professionals, Junior Medical Staff, Service User and/or Carer representatives, Pharmacy, Nursing and Medical Training leads 7.3.3 Co-opted members: any other appropriate Clinical Governance Committee member, Appointed Non-Executive Officer, Operational Director, Service Directors, Audit representative, Telecommunications representative, Legal Services Representative, emergency service staff, and any individual or organisation as deemed appropriate, determined by Resuscitation Committee 7.3.4 It is the Service Directors responsibility to ensure they are adequately represented on the Trust Resuscitation Committee to enable effective communication networks 7.3.5 Each Directorate/Locality will have an identified Lead on resuscitation who attends the Trust Resuscitation Committee and provides two way communication. 19

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