The Performance or Non-Performance of Cardio- Pulmonary Resuscitation (CPR)

(Including the framework for the use of the Automated External Defibrillator or AED)

Document Description
Document Type / Policy
Service Application / Dudley Primary Care / Community Services
Version / 2.2
Ratification date / 28/05/2009
Review date / 28/05/2010
Lead Author(s)
Gary Payne / Resuscitation Co-ordinator for Dudley PCT
Trish Squire / End of life Care Manager
Megan Page / Community Macmillan Nurse
Linda Plant / Case Manager
Presented for discussion, approval and ratification to
Core Policies and Procedures Group
Change History
Version / Date / Comments
1 / 29/11/05 / Policy ratified and passed at Core Policies and Procedures Group
1.1 Draft / 03/11/08 / Updated guidance prepared for consideration by the Core Policies and Procedures Group
1.2 Draft / 13/05/09 / Updated guidance prepared for consideration by the Core Policies and Procedures Group
2 / 28/05/09 / Amended following submission to Core Policies and Procedures Group
2.1 / 24/03/10 / Non-performance of Cardio-Pulmonary Resuscitation section (page 19-22) amended and updated to reflect new communication process with West Midlands Ambulance Service
2.2 / 25/03/10 / Formatting changes and addition of appendix 4.
Link with Standards for Better Health Domains / 1.  Safety. C1
2.  Governance. C11
3.  Accessible & Responsive Care. (covers all)
4.  Clinical and Cost Effectiveness. C5
Link with Trust Purpose and Values statements / “We are here to improve the health and well being of our local community”
1.  We will work to continuously improve services.
2.  We will value, support and develop all our staff.

Summary

This policy provides guidance for staff members working within the services of Dudley Primary Care Trust (PCT) in respect to the performance or non-performance of Cardio-Pulmonary Resuscitation (CPR) in relation to adults and paediatrics in a community setting. The document covers aspects such as national standards, training and includes the framework for use of the Automated External Defibrillator (AED).

This document has been updated in line with the Royal Marsden guidelines (Mallett J. Dougherty L. 2000), The Resuscitation Council (UK) Standards for Clinical Practice and Training (October 2004, update June 2008) and takes into account other current relevant literature.

Supporting Policies and Documents

This policy should be read in conjunction with the following organisational policies:

Ø  Management of Medical Devices Policy.

Ø  Mental Capacity Act policy.

Ø  Management of anaphylaxis in schools.

Ø  Royal Marsden Guidance (where appropriate).

Ø  Resuscitation Council CPR standards for clinical practice (2008).

Ø  Resuscitation Council AED guidance (DATE).

Ø  Emergency Treatment for Anaphylactic Reactions (Resuscitation Council (UK).

Ø  Prescribing guidance around adrenaline (PGD’s).

Ø  Consent policy.

Ø  Incident policy.

Ø  Serious Untoward Incident policy.

Ø  Medicines Management policy.

Ø  Advance Care Planning – Guidance for Professionals.

Summary of Content

This policy covers a number of issues including : Recognising when to use cardio-pulmonary resuscitation (CPR), Procedure for cardio-pulmonary resuscitation (CPR) in adults, Procedure for cardio-pulmonary resuscitation (CPR) in children, Use of automated external defibrillator (AED), Reporting incidents, Local standards, Guidance in respect to decisions not to resuscitate, Do not attempt resuscitation (DNAR) orders, Training requirements, Location of emergency equipment, management / checking of emergency equipment, Process for policy review and local systems for monitoring and audit.

Consultation Process

PCT Management Team & Staff.

Policy Review

It is the responsibility of the Resuscitation Co-ordinator to update / review this policy on a yearly basis.

Contents / Page No
Introduction / 4
Aim / 4
Roles and Responsibilities / 5
Training Requirements / Frequency of training / 6
Recommended Courses / Training Records / Unsuccessful completion of training
Performance of CPR in the Community
Action in the event of a cardiac arrest
/ 7-8
9
10-11
Adult Basic Life Support Procedure and algorithm / 12
Paediatric Basic Life Support Procedure and algorithm / 13-15
Defibrillation Framework and algorithm / 16-17
Non-performance of Cardio-Pulmonary Resuscitation (Do Not Attempt Resuscitation – DNAR) / 18-22
Hand over / Critical Incident / Debriefing / 22
Auditing / 22-23
Resuscitation Equipment / 24-25
References
Glossary / 26
27
Appendices
1.  Cardio-pulmonary Resuscitation Team Report.
2.  Daily Resuscitation Equipment Checking Record.
3.  Resuscitation Equipment Audit.
4.  DNACPR – Patient Notes Form. / 28
29
30-31
32-35


Introduction

This Policy has been revised and updated in 2008, to ensure that the needs of the service are met, and to inform and update all Dudley PCT employees of changes to the guidelines.

Sudden cardiac arrest, particularly from coronary heart disease remains one of the commonest causes of death encountered in primary care (Colquhoun & Jevon, 2000).

All PCT staff working in community and in-patient settings may be required to resuscitate the victim of cardio-pulmonary arrest or cardio-respiratory arrest.

The purpose of basic life support is to maintain adequate ventilation and circulation until help arrives. Failure of circulation for three minutes (less if the victim is initially hypoxemic), will lead to irreversible cerebral damage. Delay, even within that time, will lessen the eventual chances of a successful outcome. Emphasis must, therefore, be placed on rapid administration of basic life support.

CPR can be attempted on any person whose cardiac or respiratory functions cease, unless a “Do Not Attempt Resuscitation” (DNAR) order is in place. Failure of these functions is part of dying and thus CPR can theoretically be attempted on every individual prior to death. However, because for every person there comes a time when death is inevitable, it is essential to identify those patients for whom cardiopulmonary arrest represents the 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 competently refuse it (Royal College of Nursing, RC & BMA, 2002), ensuring that the Mental Capacity Act is followed according to the Trust policy.

Aims

The aim of this policy is to:

·  Reduce mortality and morbidity in those patients who have suffered a respiratory or cardiac arrest.

·  Ensure all Trust employees, including medical, nursing, allied health professionals, administration and managerial staff, are appropriately trained in the administration of Basic Life Support (BLS) according to their role and level of patient contact.

·  Ensure all Trust employees, according to their role and level of patient contact, are equipped with the appropriate knowledge to use an Automated External Defibrillator (AED) in the event of a respiratory or cardiac arrest.

·  To ensure that all patients for whom CPR is not to be attempted, have this decision made after consideration of all the necessary legal principles, and have it documented and communicated in an acceptable and uniform way.


Roles and Responsibilities

Legal and Statutory Duties and Responsibilities:

The organisation is subject to a number of legal, statutory and good practice guidance requirements, covering a wide range of subjects. In order to meet these requirements and to be able to demonstrate sound management within the constraints of the existing legislation it is necessary to have clear operational policies and procedures.

Chief Executive:

The Chief Executive has overall responsibility for the strategic direction and operational management of the PCT, including ensuring that the Trust policies comply with all legal, statutory and good practice guidance requirements.

Trust Board:

The Trust Board has responsibility for setting the strategic context in which organisational policies and procedures are developed, and for establishing a scheme of governance for the formal review and approval of policies.

Directors:

Each Director is responsible for:

·  Identifying, developing and implementing policies relevant to their area of responsibilities. The Director will sponsor the development or review of a policy.

·  Ensuring necessary training or education needs and methods required to implement the policies are identified and resourced or built into the delivery planning process.

Managers:

It is Managers responsibility to ensure that all their staff follow Trust policies / guidelines, and allocate study time in which staff can attend appropriate training.

Trust Resuscitation Officer:

It is the responsibility of the Resuscitation Officer to:

·  To write and keep up to date the Trusts Resuscitation policy informing its employees of any changes.

·  Co-ordinate, deliver and audit the training programme.

·  Support and give expert advice to all PCT employees regarding this specialist field.

Education and Training Department:

To provide the Trust with adequate training sessions, ensuring the needs of the service are met, ensuring we are complying with the statutory and mandatory requirements that are required for our Trust and all its employees.

Clinical Staff

All clinical staff are responsible for ensuring that they attend annual mandatory resuscitation training. It is ultimately the individual’s responsibility to ensure that they have the skills necessary to carry out their duties to the best of their ability and where skills need updating, that this is done as soon as possible.

When any member of staff is involved in a resuscitation attempt whilst on duty, the incident must be reported to the Clinical Governance Department using either an incident form or the Sentinel reporting system.

Resuscitation Training

Staff should undergo a minimum of yearly resuscitation training to a level appropriate to their expected clinical responsibilities.

All those in direct contact with patients should be trained in BLS and related resuscitation skills. As a minimum they should be able to provide effective BLS with an airway adjunct such as a pocket mask. Doctors, nurses and other multidisciplinary team members like physiotherapists, occupational therapists should also be able to use an AED effectively. It is unacceptable for patients who sustain a cardio-pulmonary arrest to await the arrival of the ambulance service before CPR is performed and a DC shock is administered when a (AED) defibrillator is available.

Clinical staff must update their skills annually.

(Resuscitation Council (UK) 2001, 2004 – update June 2008)

Training Requirements

All training provided will be delivered by personnel who hold a current qualification as an instructor for the Resuscitation Council (UK) and a Advanced Life Support certificate with training in the use of AED. Training will be carried out in accordance with, and conform to, current Resuscitation Council (UK) published recommendations.

Staff who successfully completes a course of instruction in the use of an AED will receive a certificate, valid for one year. All staff authorised to use the defibrillator must familiarise themselves with the contents of the operation and service manual supplied with each defibrillator in their area of work.

All PCT front line staff who have direct patient contact must attend a yearly basic life support update.

It is recommended that all front line staff who have direct patient contact (e.g. GP Receptionists), attend a yearly basic life support update.

Recommended Courses

Target Staff Group / Key components / Validating body / Refresher/
Duration / Course
ALL staff with patient contact, if not undertaking any other course
/ Basic Life Support
Paediatric Basic Life Support (infant and child) / Dudley PCT / YEARLY
3 hours / Adult Basic Life Support (BLS)
ALL staff that have AED on site / Basic Life Support
Paediatric Basic Life Support (infant and child), airway management, use of Automated
External Defibrillator / Dudley PCT / YEARLY / 6 MONTHLY
4 hours / Resuscitation & AED Training


Training Records

The Trust Resuscitation Co-ordinator will maintain records of all staff having attended resuscitation training.

Individual staff training records will be updated by Resuscitation Co-ordinator / Education and Training Administrative staff following each training session using the Trust’s Training Database, once the staff member has completed the training session the information is then added to electronic records for each individual staff member. It is then the responsibility of each individual and their line manager to ensure they keep updated with the resuscitation training.

Unsuccessful Completion of Training

Any member of staff who does not meet the required standards in the training session will be given the opportunity to undertake further training within 7 / 14 days. If, after additional training the required standards have still not been achieved the individual’s manager or supervisor will be contacted and informed, and an action plan will be devised to support them to achieve the outcomes and realise their potential.

Basic Life Support

A minimum of 90% (CNST level 3 standards) PCT staff must receive BLS and, if appropriate, AED training or appropriate updates, annually.

Theoretical training alone without actual practice in a simulated environment, for example on training manikins, is of limited value. The use of manikins is therefore mandatory.

Basic Life Support training will be required for all employees required to be able to operate an automated external defibrillator (AED), i.e. GPs, nursing staff, AHPs, front-line reception staff.

The Resuscitation Co-ordinator will be responsible for providing training to all PCT staff. CPR Link Nurses (core trainers) will continue to offer “in-house” training to increase staff familiarity with the emergency equipment within their own clinical environment.

Performance of Cardiopulmonary Resuscitation in the Community

Introduction

Currently 95% of people with cardiac arrest occurring in the community die. As many as 1 in 5 people who have a cardiac arrest do so in a public place. Once somebody has suffered a cardiac arrest, the sooner defibrillation is provided the higher the likelihood of a successful resuscitation. The prompt institution of BLS will buy time but prompt defibrillation will increase the chance of saving the person. Ambulances may take several minutes to reach the scene; let the paramedics take over after the patient has been defibrillated (Department of Health, 2003).

Every emergency ambulance in the UK carries a defibrillator and the ambulance service should be involved at the earliest opportunity as part of a dual response.

.

Specific Detail

Performance of Cardiopulmonary resuscitation in the community covers all locations. PCT staff may treat patients other than in a hospital location. This will include for instance, Day Units, Schools and indeed the patients’ own home.

The Procedure Is:

1.  Assess for a safe environment.

2.  First responder shouts for Help! (In some instances e.g. patient’s home, this may not be an option).