Crossroads CareResuscitation guidance (adults)

B.03c

Adults’ resuscitation guidance for care workers

1.0 SCOPE

1.1 This guidancerelates to adults aged 18 and over. There is separate guidance( C.04c) for children and young people aged 17 and under.

1.2 The intended outcome of this document is to ensure each service user receives prompt, effective resuscitation provision in line with their individual wishes and requirements.

1.3 Pending the development of guidance specific to volunteers, this guidance will apply to all volunteers (including trustees) to the extent that the content is relevant to them in the course of their volunteer work with Crossroads Care.

1.4 Crossroads Care recognises the added value that volunteers can bring to its services and this is reflected by the wide variety of roles they perform. However, the nature of the organisation’s relationship with volunteers is very different to the one it has with paid employees. Volunteers will not:

  • provide personal care services / support with medication in people’s homes (see Crossroads Care’s policies on personal care and medication)
  • undertake roles where the prompt attendance of the volunteer at a specified time / venue is essential to the safety or wellbeing of a service user.

2.0 DEFINITIONS

2.1 Appendix 1 at the end of this document provides definitions of the following terms:

  • resuscitation
  • cardio-pulmonary resuscitation (CPR)
  • basic life support
  • Do Not Attempt Resuscitation (DNAR) / Do Not Resuscitate (DNR) instructions
  • Advance Decisions
  • terminal illness
  • palliative care
  • end of life care
  • anaphylactic shock.

3.0 EMERGENCY SITUATIONS

3.1If a service user suddenly or unexpectedly stops breathing or their heart stops whilst you are working with them, you are required to:

  • start resuscitation whilst you wait for the emergency services to arrive
  • summon the emergency services by calling 999
  • inform your line manager / the person on call what has happened.

3.2 You will be trained in resuscitation techniques (including basic CPR and the treatment of anaphylactic shock), and it is our policy that you provide this support until the emergency services arrive.

3.3Your line manager will let you know about any service users who do NOT want to be given resuscitation in an emergency, and this will be clearly written in their care plan (see 4.0 and 5.0 below).

4.0 CARE plans

4.1If the person you care for hasproblems with their heart or with breathing, the care planner will find out what treatment they want to receive. The care plan will then give all the details of what action you need to take if the person’s heart or breathing stops.

4.2 The care plan will also state whether the person with care needs has any known serious allergies that might result in anaphylactic shock and what actions you need to take if this happens (see also 6.1 below).

4.3The care planner will routinely review and update care plans every year or sooner if a person’s circumstances or health change. If you notice that a person’s care plan contains out-of-date information, let your line manager know straight away.

5.0 DNAR / DNR INSTRUCTIONS AND ADVANCE DECISIONS

5.1 Not everyone wants to be resuscitated if their heart or breathing stops. If a person is terminally ill or is veryweak and frail, they may prefer to be allowed to die in peace rather than to go through the trauma of CPR.

5.2 Some service users may have a DNAR / DNR instruction in placeor havemade an Advance Decision that statesthey do not wish to be resuscitated.If this is the case, the care planner willcheck that the DNAR / DNR instruction or the Advance Decision is legal and valid before you start to provide a service.

5.3Details of the DNAR / DNR instruction / Advance Decision will be written in the care plan, including where in the home the document is located.

5.4If you try to resuscitate a person when they have a DNAR / DNR instruction in place or have made an Advance Decision not to be resuscitated, your actions could be interpreted as physical assault.You have to respect the person’s wishes.

5.5Unless the care plan tells you otherwise (see 5.6 below), if a person has a DNAR / DNR instruction or has made an Advance Decision not to be resuscitated and they suddenly or unexpectedly collapse:

  • summonthe emergency services immediately by calling 999
  • when the emergency services arrive, tell them about the DNAR / DNR instruction / Advance Decision straight away.

5.6 However, the person with care needs and their family may have asked that, if the person’s heart or breathing stops, you donot call for an ambulance, but instead you contact the main carer or another named person. All the details will be written in the care plan. If this happens to you, contact your line manager / the person on call straight away and they willgive you the help and support you need.

5.7Just because someone has aDNAR / DNR instructionor has made an Advance Decision not to be resuscitated, thisdoes not mean that all other treatment stops.You are still expected to give the person all the care they need, as directed in the care planin order to keep them as comfortable as possible.

5.8Please note: In no circumstances are you allowed to act as witness to the signing of Advance Decisions.

5.9 If you are caring for someone who has made a DNAR / DNR or Advance Decision not to be resuscitated and you are concerned about it or have anyquestions, get in touch with your line manager to discuss it with them.

5.10 You may opt out of providing palliative care or end of life care or care for those with DNAR / DNR instructions or who have made Advance Decisions with no penalty, although this may affect the amount of work Crossroads Care is able to offer to you.

6.0 anaphylactic shock

6.1 As part of your first aid training you will be taught how to handle anaphylactic shock, including how to give medication using an EpiPen. If the affected person does not have an EpiPen:

  • call for an ambulance by calling 999 immediately
  • contact your line manager / the person on call for further guidance.

7.0 What to do in the event of a death

7.1 Ifyou suspect that a service user has died:

  • start emergency first aid procedures unless restrictions apply (see 5.2 above)
  • contact the emergency services, unless otherwise instructed (see 5.6 above)
  • informyour line manager / the person on call .

7.2 Your line manager / the person on call will sort out who is going to contact the person’s doctor and next of kin.

7.3 If you have beenin a situation involving resuscitation or sudden death of a service user, you will be offered support by your line manager or other senior staff member. You might also want to contact FirstAssist who offer Crossroads Care staff a confidential, independent counselling and support service. Their details are given in Appendix 2 at the end of this document.

8.0 Confidentiality

8.1 If a service user has a DNAR / DNR instruction in place or has made an Advance Decision not to be resuscitated, managers will make sure that all staff members working with that person are fully aware of their wishes. If you are aware thatanother staff member who needs to know hasnot been given this information then pleaselet your line manager know.

8.2 Make sure you followCrossroads Care’sguidance on data protection (A.03d) and confidentiality (D.11c) at all times. If you don’t , the matter may be dealt with under the disciplinary policy.

9.0 record keeping and reporting

9.1 If you or a service user has an accident or you witness an accident or incident at work (including resuscitation events or deaths),report itto your line manager / the person on call immediately and record the incident on the client report form in the person’s home. You line manager will let you know what other paperwork you need to fill in, which will include an incident report form (DT.03).

10.0 LEARNING AND DEVELOPMENT

10.1 General learning and development requirements relevant to the adults’ resuscitation policy, procedure and guidance are contained in the learning and development guidance (E.13). Additional specific training information is documented below.

10.2 You will be given first aid training(including emergency life support and CPR) as part of your induction training and it will be updated at least every three years. It is an insurance requirement that you do this.

11.0 ACCEPTANCE OF ADULTS’ RESUSCITATION GUIDANCE

11.1 You are required to sign to indicate that you have received, read and understood the content of the adults’ resuscitation guidance as directed by your line manager.

11.2 On completion of training, it is your personal responsibility to follow the adults’ resuscitation guidance. Failure to do so may result in disciplinary proceedings.

APPENDIX 1

DEFINITIONS OF TERMS USED

1. Resuscitation is the emergency treatment given when a person’s heart stops beating and / or they stop breathing. It can include:

  • opening the person’s airway
  • placing the casualty in the recovery position
  • basic cardio-pulmonary resuscitation.

2.Cardio-pulmonary resuscitation (CPR) is the action taken to provide effective ventilation and circulation when a person’s breathing and heart beat have stopped. It can include:

  • mouth to mouth breathing
  • chest compressions.

3.Basic life support is the first stage of resuscitation and means you don’t use any special equipment (such as a defibrillator).

4. A Do Not Attempt Resuscitation (DNAR) or Do Not Resuscitate (DNR) instruction means the person concerned has made a decision that they do not want any action taken to resuscitate them if their heart stops or if they stop breathing. This instruction can only be issued by the person’s medical team (for example their consultant or General Practitioner). Further details are available at:

5. An Advance Decision (also known as Advance Statement, Advance Directive and Living Will) givesdetails of the treatment an individual wantsto receive if they become unconscious, unable to communicate their wishes or do not have the mental capacity to make a decision. It may include a DNAR / DNR instruction.

6.Terminal illness means any illness that ends in death. There is no possibility of recovery.

7. Palliative careis the combination of active and compassionate therapies aimed at reducing the symptoms and suffering of individuals and families facing a life-threatening illness.

8. End of life careis an important part of palliative care, and usually refers to the care of a person during the last part of their life, from the point at which it has become clear that the person is in a progressive state of decline.

9. anaphylactic shock is a sudden, severe allergic reaction to a foreign substance, such as a drug, some foods or bee venom. When it happens:

  • the person’s blood pressure will drop sharply
  • they may get itching welts on the skin
  • they will experience breathing difficulties.

The reaction may be fatal if the person concerned does not get emergency treatment immediately.

APPENDIX 2

FIRSTASSIST TELEPHONE COUNSELLING SERVICE

FirstAssist provides a confidential British Association for Counselling and Psychotherapy (BACP) accredited service and is the UK’s leading provider of telephone counselling services. Each telephone counsellor is a direct employee of FirstAssist and is trained to diploma of counselling (or equivalent) as a minimum qualification. All FirstAssist counsellors have at least two years post-qualifying, clinically supervised, counselling experience.

By employing the right quality and quantity of telephone counsellors, FirstAssist provides a powerful and effective counselling service via the telephone.

Each telephone counselling session can last for up to 50 minutes and the caller can continue to work with their counsellor on an ongoing basis; scheduling convenient appointments for each session.

Research has shown that telephone counselling can be at least as effective as that delivered face to face. In addition, this proven method offers callers the combination of convenience and, where desired, anonymity.

FirstAssist counsellors can work with a wide range of issues, including (but not limited to):

  • relationship difficulties
  • bereavement
  • stress
  • anxiety
  • emotional problems
  • work related issues
  • family difficulties
  • debt

All telephone counsellors are subject to formal monthly clinical supervision as well as having 24 hour access to a clinical supervisor for times of particular need. All supervision is provided by a team of FirstAssist clinical supervisors.

The contact details for this service are:

Telephone number 01455 251 500

Quoting scheme number 71422

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Policy/Adultresuscitation/2011/11/APb003cLast updated October 2013

© Carers Trust 2013 Review due October 2014