CARDIOPULMONARY RESUSCITATION (CPR) POLICY (for Adult ... · Title: Cardiopulmonary Resuscitation...

Title: Cardiopulmonary Resuscitation (CPR) Policy (for Adult, Maternity and Paediatric patients) Version: v1.1 Issued: January 2020 of 47

CARDIOPULMONARY RESUSCITATION (CPR) POLICY (for Adult, Maternity and Paediatric patients)

POLICY

Reference CPG-RESU-001

Approving Body Deteriorating Patient Group

Date Approved 19th October 2017

Issue Date 8th January 2020 with minor amends

Version 1.1

Summary of Changes from Previous Version

Minor amends for staff titles/ jobs; reference to the ReSPECT policy and change from AND to DNACPR.

Supersedes

v1.0, Issued 26th October 2017 to Review Date October 2020

Document Category Clinical

Consultation Undertaken

Resuscitation Department

Resuscitation Advisory Group

Deteriorating Patient Group

Date of Completion of Equality Impact Assessment

03/11/2017

Date of Environmental Impact Assessment (if applicable)

Not Applicable

Legal and/or Accreditation Implications

Support Adherence to Resuscitation Council(UK) latest Guidelines and agreed local Mandatory Training Dictates inclusive of National Core Skills for Health

Target Audience

All staff employed within Sherwood Forest Hospitals NHS Foundation Trust (the Trust) have a duty to respond and provide help appropriate to their role, level of responsibility and training on discovery of an individual who is suspected of/ has sustained a cardiopulmonary arrest. All staff identified in the Mandatory Training Policy will receive resuscitation training to a level and frequency appropriate to their role.

Review Date October 2020

Sponsor (Position) Medical Director

Author (Position & Name) Resuscitation Training Manager, Christine Miles

Lead Division/ Directorate Corporate

Lead Specialty/ Service/ Department

Human Resources/ Training and Development/ Resuscitation

Position of Person able to provide Further Guidance/Information

Resuscitation Training Manager and other staff in the Resuscitation Team

Associated Documents/ Information Date Associated Documents/ Information was reviewed

Not Applicable

Not Applicable


CONTENTS

Item Title Page

1.0 INTRODUCTION 3

2.0 POLICY STATEMENT 3

3.0 DEFINITIONS/ ABBREVIATIONS 4-5

4.0 ROLES AND RESPONSIBILITIES 5-6

5.0 APPROVAL 7

6.0 DOCUMENT REQUIREMENTS 7-15

6.1 Procedure for Cardiopulmonary arrest 7

6.2 The Emergency Response Team 9

6.3 Clinical Emergencies in Other Areas 10

6.4 Equipment 11

6.5 Cardiopulmonary arrest in Special Circumstances 13

6.6 Post Resuscitation Care 14

6.7 Patient Transfer 14

6.8 The Resuscitation Advisory Group 15

7.0 MONITORING COMPLIANCE AND EFFECTIVENESS 16-17

8.0 TRAINING AND IMPLEMENTATION 18-22

9.0 IMPACT ASSESSMENTS 22

10.0 EVIDENCE BASE (Relevant Legislation/ National Guidance) and RELATED SFHFT DOCUMENTS

22

11.0 KEYWORDS 23

12.0 APPENDICES (list) 23

Appendix Ia Emergency Response Teams KMH Appendix Ib Emergency Response Teams Newark Hospital Appendix II Emergency/ Resuscitation Box Contents – Paediatric Appendix III Resuscitation Trolley Contents List – Adult Appendix IV PREM Trolley Contents Appendix V Additional Equipment List Appendix VI Number & Location of Paediatric Emergency Equipment Appendix VII Number & Location of Cardiac Arrest Trolleys Appendix VIII Newark Hospital Policy Variances Appendix IX Mansfield Community Hospital Policy Variances Appendix X Difficult Airway Algorithm Appendix XI KTC Emergency Assistance Protocol Appendix XII Guide to Staff Resuscitation Training Appendix XIII Equality Impact Assessment Form

24 25 26

27-29 30-32

33 34

35 36 37

38-39 40

41-45 46-47


1.0 INTRODUCTION This policy outlines the systems, processes and structure in place throughout the organisation to provide safe and effective care during resuscitation events to all persons attending Sherwood Hospitals Foundation Trust. This policy should be viewed interactively in context with other organisational policies regarding the management of deteriorating patients or clinical emergencies. The quality and monitoring of resuscitation provision has been directly influenced by the Resuscitation Council (UK) Quality Standards for Cardiopulmonary Resuscitation Practice and Training in the Acute Care Setting1. 2.0 POLICY STATEMENT In an attempt to reduce the amount of cardiopulmonary arrest events, this policy interfaces with The Observations and Escalation Policy for Adult In-Patients to provide multi-professional teams with guidance regarding safe, effective patient assessment both on admission and throughout an episode of care2. The policy provides direction for staff regarding their roles, responsibilities and actions in order to provide care and summon assistance in clinical emergency situations. Scope of Policy:

a. Staff Groups: All staff employed within Sherwood Forest Hospitals NHS Foundation Trust (the Trust) have a duty to respond and provide help appropriate to their role, level of responsibility and training on discovery of an individual who is suspected of/ has sustained a cardiopulmonary arrest. All staff identified in the Mandatory Training Policy will receive resuscitation training to a level and frequency appropriate to their role.

b. Clinical Areas:

This policy applies to all areas of all sites of SFHFT.

c. Patient Group: All patients under the care of the Trust, visitors or staff that require resuscitation will be managed in accordance with the specifications outlined in this policy. The information reflects the current national standards of the Resuscitation Council (U.K) (The standards include guidance from The Royal College of Anaesthetists, Physicians and the Intensive Care Society).

d. Exceptions:

Patients with a current valid and applicable Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) clearly documented in their medical notes in accordance with the Trust’s ReSPECT Policy.

Children with a current valid and applicable Personal Resuscitation Plan which identifies that CPR would be inappropriate.

1 Resuscitation Council (UK) Quality standards for cardiopulmonary resuscitation and training – acute care (May 2017)

2 NICE Clinical Guideline 50 (July 2007) Recognition of Acutely Ill Patients in Hospital

https://www.resus.org.uk/quality-standards/acute-care-quality-standards-for-cpr/


http://sfhnet.nnotts.nhs.uk/content/showcontent.aspx?contentid=47183

http://sfhnet.nnotts.nhs.uk/admin/webpages/default.aspx?RecID=2055

http://www.resus.org.uk/


http://www.nice.org.uk/guidance/CG50/chapter/introduction


3.0 DEFINITIONS/ ABBREVIATIONS

The Trust/SFHFT Sherwood Forest Hospitals NHS Foundation Trust.

Cardiopulmonary arrest The patient will be unresponsive, not breathing adequately and have no other signs of life.

Cardiopulmonary Resuscitation (CPR)

Chest compressions combined with artificial ventilation.

Defibrillator

Medical device designed to reset the electrical activity of the heart when in an abnormal rhythm using a short burst electrical current.

AED Automated External Defibrillator; as manual defibrillator but AEDs will guide and advise a rescuer through the process and make decisions about whether a shock is needed for the casualty. A shock can only be delivered if deemed appropriate by the device.

EAU Emergency Admissions Unit at King’s Mill Hospital site

ED Emergency Department at King’s Mill Hospital Site

UCC Urgent Care Centre at Newark Hospital site

EMAS East Midlands Ambulance Service

Resuscitation Advisory Group (RAG)

On behalf of the Trust Patient Quality and Safety Board have delegated responsibility to oversee, develop and implement Trust policies, procedures and guidelines, identify and manage risk associated with resuscitation events.

Resuscitation Dept. On behalf of the organisation have responsibility to provide specialist support, advice, training, audit and governance-related activity.

Resuscitation Officer (RO) Clinical staff member working within the Resuscitation Department and employed by the trust to support the development and maintenance of the trusts ability to deliver safe and effective resuscitation services.

Resuscitation Champion Designated staff members within a clinical area who have received appropriate training and support to act as a resource to monitor equipment checks and provide resuscitation related information, advice and training for staff working within their own clinical environment

HOOHP Hospital Out of Hours Practitioner

CCOT Critical Care Outreach Team

Staff All employees of the trust, including those managed by a third party organisation on behalf of the trust.

MEMD

Medical Equipment Management Department.

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)

A treatment directive to identify that it would be clinically appropriate for the patient not to receive cardiopulmonary resuscitation should their heart and breathing stop. All other agreed treatment interventions will be provided.

Resuscitation Trolley Sealed trolley system stocked with emergency equipment and drugs. Designed to support staff in managing patients safely and effectively at the point of care during a clinical emergency.


PREM Trolley Paediatric Resuscitation Emergency Management system to ensure a comprehensive selection of emergency equipment is readily available. Uses the same sealed system as the resuscitation trolley.

Newborn Resuscitation Trolley

Sealed trolley system for the management of resuscitation and support of premature and newborn babies at delivery.

Paediatric/children Young people from the age of 28 days to the age of 16.

Neonate Children from birth to 28 days

Obstetric Care of pregnant mothers

4.0 ROLES AND RESPONSIBILITIES All trust staff

There is a responsibility on all trust staff to immediately escalate to their line manager any concerns about potential or actual barriers to the trusts ability to comply with the standards outlined within this policy.

Resuscitation Advisory Group

Implementation of the CPR Policy recommending that all staff comply with this policy.

Implementation of and adherence to the Cardiac Arrest Governance Framework.

Work in partnership with the Resuscitation Department to facilitate adherence to this framework.

Report provision to the Deteriorating Patient Group (DPG), and through them to the Patient Safety and Quality Board (PSQB), and the Mortality Surveillance Group (MSG) regarding all aspects of the resuscitation service.

Resuscitation Department

Provision of specialist advice, support and training across the organisation.

Provide specialist advice and guidance to the organisation regarding resuscitation services, ensuring adherence to national guidelines.

Provision of national and local governance-related auditing and reporting for cardiac arrest & related resuscitation services.

Work collaboratively with colleagues from MEMD to ensure provision and maintenance of resuscitation equipment to maintain a safe environment.

Divisional General Managers, Clinical Directors, Heads of Nursing

Have an awareness of the operational requirements of this policy.

Ensure that resources and support systems are in place to enable staff to implement the care outlined within the policy.

Ward/Department Leaders/ Line Managers

Ensure staff perform daily resuscitation equipment checks and record activity on the appropriate emergency equipment daily check logs

Monitor audit data for their area located on the global nursing metrics system and respond promptly to any evidence of poor compliance to this activity (further reference to this can be found in section 5.6 e) & f) )

Ensure that the policy and attached procedures are adhered to.

Ensure all cardiopulmonary arrests and other related incidents are reported appropriately using the Datix system in accordance with the Cardiac Arrest Governance Framework.



Support staff to maintain their skills and knowledge to a level appropriate to their expected clinical responsibilities by facilitating attendance on resuscitation training courses.

Resuscitation Champions

No person will undertake this role unless they have their manager’s support and have attended a Resuscitation Champion training session provided by a Trust Resuscitation Officer.

Demonstrate and reinforce effective resuscitation techniques at all times in accordance with the Resuscitation Council (UK) Guidelines both in the delivery of training and at resuscitation events.

Maintain own competence, knowledge and skills in CPR by attending review days and Link staff meetings.

Resuscitation Champions will assist the Resuscitation Officers to cascade any relevant information or training to clinical staff that impacts on resuscitation techniques, equipment or adherence to governance related activity.

Report any concerns relating to resuscitation issues to their line manager and the Resuscitation Officers relating to the delivery of training, equipment and actual clinical events.

Support the provision of basic life support training and approved assessment to all clinical staff within their area, and provide a register of all training completed to the Resuscitation Department.

Support the provision of basic life support training as part of the trust annual mandatory update.

All Employees

Must not expose him/herself or any other person to any risk of injury during the provision of emergency medical assistance. Staff should refer to guidance in the Moving & Handling Policy and the Sharps & Needlestick Policy.

Ensure awareness and effective daily communication of the resuscitation status of all patients in their care, inclusive of those patients who have an Allow Natural Death (AND) order or Personal Resuscitation Plan in place and respect this accordingly.

Professional accountability for attendance at identified mandatory training events within specified time scales.

Are personally responsible for ensuring their knowledge, skills and familiarity with the medical emergency team activation system and the location of resuscitation equipment within their clinical environment are all kept up to date.

Ensure all cardiopulmonary arrest events are reported using the Datix risk management reporting system, irrespective of whether a 2222 cardiopulmonary arrest call has been instigated or not.

Ensure all resuscitation equipment is available, checked daily and replaced immediately after use.

Report any defective resuscitation equipment to their line manager and the MEMD Department immediately, whilst ensuring a contingency plan is instigated to access alternative equipment in the interim period.

Staff must inform their line manager as soon as possible, if they have a physical condition that would prevent them from performing effective CPR, should they be required to do so while on duty.

https://www.sfh-tr.nhs.uk/media/7197/hs-mhp03-moving-and-handling-policy-v9-feb-2018.pdf



5.0 APPROVAL Following consultation, this policy has been approved by the trust’s Deteriorating Patient Group. 6.0 DOCUMENT REQUIREMENTS (POLICY NARRATIVE) 6.1 PROCEDURE FOR CARDIAC ARREST

This policy should be read and aligned appropriately with the ReSPECT Policy to provide timely decision making with regard to the appropriateness of CPR for each of our patients on an individual basis.

For those adult patients with a short duration admission period who are deemed to be in the dying phase, and a DNACPR order is not yet in place, it is the responsibility of the most senior clinician present to determine if CPR is appropriate, or promptly declare and document CPR is inappropriate and complete a ReSPECT form.

Action to be taken where CPR has been deemed clinically appropriate: When a cardiac arrest has been clinically confirmed, a member of staff will; summon help and commence CPR. Additional staff will take the appropriate resuscitation trolley, defibrillator, oxygen and suction equipment (if portable) to the patient for immediate deployment and telephone switchboard using the number 2222 to summon appropriate expert help.

The Activation System to Summon Help i. All emergency response team members are issued with a bleep that

incorporates a speech facility. ii. Upon receipt of a 2222 call, the switchboard operator will activate the requested

team members’ bleeps. iii. A rapid high intermittent tone will be heard followed by the speech facility

providing notification of the location of the emergency/arrest. iv. A test of emergency bleep function for all response teams will be carried out by

the switchboard team every 12 hours. v. Bleep holders must respond to emergency bleep tests on the number stated to

support the trust’s ability to ensure safe and effective operation of our emergency response functions.

vi. A second request for response will be issued individually to non-responders as necessary.

vii. If the bleep is malfunctioning or the holder suspects a malfunction it should be returned immediately to the switchboard and a replacement will be issued.

viii. When a baton bleep is held, members of the resuscitation team must personally hand over the bleep to the appropriate relief staff commencing duty.

ix. Records of staff responses to bleep tests will be provided to service leads to monitor compliance with the expectation that non-response will be addressed and managed.

x. The 3000 number may also be used in an emergency to summon urgent role specific medical assistance in preference to 0.

xi. If 2222 is dialled in error, staff must inform switchboard of the error before replacing the receiver.



When dialling 2222, inform the switchboard operator by stating clearly the exact location of the patient and the specific team(s) required (see Appendix Ia / Appendix Ib).

It is the responsibility of the staff member placing the call to ensure correct, specific information is given to the switchboard operator.

If the call is regarding a neonate, this must be referred to as a Neonatal emergency.

If it is regarding a child, this must be referred to as a Paediatric emergency.

In situations where an adult patient is not in arrest but staff require rapid clinical support to maintain patient safety due to the severity of the patient’s condition then a 2222 call should be made asking for the Cardiac Arrest team

If insufficient members of the arrest team arrive, or there appears to be an inappropriate delay in response, repeat the 2222 call. Create a Datix system alert if this occurs & results in suboptimal patient care

If the victim location is on a Trust site but external to a building, e.g. a car park, ensure a 2222 call is placed using the nearest internal telephone to summon the cardiopulmonary arrest team, stating the exact location. If transport will be required to transfer the patient to the Emergency Department, additionally call 999 to request an ambulance.

If the doctor in charge identifies that a sufficient number of skilled clinicians are already present, e.g. Theatres, Intensive Critical Care Unit (ICCU), Emergency Department (ED), Coronary Care, specific members of the cardiac arrest team may be fast-bleeped via switchboard by dialling 3000 or 2222. Alternatively the Vocera system may be used to summon an individual clinician urgently.

Once CPR has been initiated, it will be the decision of the cardiac arrest team leader when to terminate the resuscitation attempt. (It is advised that standard practice for the team leader is to evoke a consensus of opinion from all team members on this issue.)

At a paediatric arrest, the on-call Paediatric Consultant will decide when to terminate the resuscitation attempt.

If the cardiac arrest is witnessed (this is very frequent in the paediatric situation), the cardiac arrest team leader must ensure a member of staff has been assigned to support the witness(s) throughout the event

All cardiac arrests must be reported using the Datix incident reporting system

Cardiac arrest team members should ensure they are familiar with the Trust’s ReSPECT Policy.


6.2 THE EMERGENCY RESPONSE TEAMS

With the exception of the Acute Response Team (see The Observations and Escalation Policy for Adult In-Patients) and at Mansfield Community Hospital emergency response calls are activated by dialing 2222. For Newark Hospital variances please refer to Appendix VIII For Mansfield Community Hospital variances please refer to Appendix IX

King’s Mill Site (including the Renal Unit & PC24)

Acute Response Team (ART) (response in SFHFT inpatient areas only)

Critical Care Outreach Nurse (07:45-23:30).

Hospital Out of Hours Practitioner (HOOP) (23:30-07:45).

Medical Registrar on-call.

Anaesthetic Registrar on-call.

Adult Cardiac Arrests/Adult Medical Emergencies

Medical Registrar on-call.

Junior Doctor on-call.

Anaesthetics 1st on-call.

Senior Nurse, Ward 23.

Duty Nurse Manager.

Hospital Out of Hours Practitioner (HOOHP) (20:00-08:00).

The Resuscitation Officer (09:00-17:00, Mon-Fri). Additional clinical staffing roles receive cardiopulmonary arrest calls and are expected to attend any incident within the location of their professional responsibility to enhance cardiopulmonary arrest management skills.

Trauma Team

ED consultant.

ED Middle Grade.

Radiographer.

Anaesthetics 2nd on-call.

Orthopaedic registrar on-call.

Surgical Registrar on-call.

Resuscitation Officer (09:00-17:00, Mon-Fri).

Hospital Out of Hours Practitioner (HOOHP) (20:00-08:00).

For Paediatric Trauma also call 3000 and fast bleep the Paediatric registrar on-call.

Neonatal Emergencies

Paediatrics Registrar on-call.

Paediatrics Junior Doctor on-call.

Sherwood Birthing Unit Coordinator

On-call Paediatric Consultant via mobile - at the discretion of the Paediatric Registrar




Paediatric Emergencies

Paediatrics Registrar on-call.

Paediatrics Junior Doctor on-call.

Anaesthetics 2nd on-call.

Ward 25 Nurse Coordinator.

Resuscitation Officer (09:00-17:00, Mon-Fri). If further medical assistance is required, contact via switchboard by dialling 3000 or 2222 and request a fast-bleep of the specific person/role.

Obstetric Emergencies

Obstetric Registrar on-call.

Sherwood Birthing Unit Coordinator.

Obstetric Junior Doctor on-call.

Obstetric Consultant on-call (on site 08:30-18:30, mobile via switchboard out of hours)

In the event of an obstetric cardiac arrest, the obstetric emergency procedure must be instigated using the 2222 number and additionally ask for the Adult Cardiac Arrest team. In either event if delivery of baby is likely to be necessary then the Neonatal Emergency Team should also be requested.

6.3 CLINICAL EMERGENCIES IN OTHER AREAS

The King’s Treatment Centre (KTC) Protocol for Summoning Emergency Assistance Please refer to Appendix XI. The KTC staff have a dual option to summon assistance in accordance with the persons’ need:

Dial 2222 if the person is unable to speak.

Dial 3000 and request a fast bleep of the KTC Nurse Leader (Site Co-ordinator out of office hours) if the person is able to speak.

Procedure for Managing an Emergency on Site but External to Buildings

Summon assistance from clinically trained staff/first aider in the nearest department to the event.

Dial 2222 via switchboard and request the medical emergency/cardiac arrest team if life is threatened and dial 999 for EMAS ambulance support to transfer the casualty.

Collect the nearest Outdoor First Responder Bag (located on KTC Main reception & EAU at KMH, utilise UCC resources at Newark & EMAS at MCH) and AED.

Provide emergency medical aid to the victim using the equipment in the bag. Commence CPR immediately & deploy the AED on its arrival if cardiac arrest evident.

Management of this situation should reflect a pre-hospital rather than in-hospital situation. Stabilisation of the victim as much as the situation permits and rapid transfer to an in-hospital emergency care environment (usually the Emergency Dept.) is the priority, as opposed to attempting to instigate full emergency management in a potentially challenging environment with limited resources.


6.4 EQUIPMENT

a. More detailed information relating to resuscitation equipment can be found by accessing the Resuscitation Equipment Guide. This is located in the folder with every resuscitation trolley or via the Resuscitation Dept section of the intranet.

b. All Clinical staff will be familiar with the location and operative use of available resuscitation equipment within their working environment. The importance of this is emphasised in those areas where equipment is shared (e.g. the King’s Treatment Centre).

c. Both of the defibrillator models at SFHFT run diagnostic self-checks overnight, they must be checked by clinical staff each morning to ensure the test has been successful and they are ready for use.

d. For Zoll R-series devices, ensure pads are pre-connected to the defibrillator and in date.

e. Areas that have a Philips FR2 model AED should ensure pads are not kept with the device; the correct pads for this model are stored in the top drawer of the sealed resuscitation trolley.

f. Areas that do not access the MEMD resuscitation trolley schemes are responsible for ensuring the availability of resuscitation equipment and that it is checked daily and in full working order.

g. All resuscitation equipment will be situated in a central, clearly visible location to facilitate rapid unimpeded access (resuscitation bays in most areas).

h. A Healthcare Professional working in each area must perform checking of the equipment daily. This check must be recorded on the appropriate emergency equipment daily check log. Areas are not in use on certain days will not be expected to check during these times but the log must show the reason why checks are not performed at these times.

i. The operational readiness of equipment and its maintenance is the responsibility of the Registered Nurse/Professional Lead on each shift on the ward/department in which the equipment is sited. The Ward/Department manager and MEMD should be notified immediately if a fault is detected.

j. If a fault will impede resuscitation attempts, it is the responsibility of the Ward/Department Lead in the interim period to ensure access to replacement equipment is established. (If an immediate replacement is not available, contingency arrangements will need to be identified and robustly communicated to all affected staff).

RESUSCITATION BACKUP POINTS

a. These are the central points for exchange of sealed emergency equipment systems at each of our three hospital sites and in some cases for central storage of additional emergency equipment.

b. They are located:

King’s Mill Hospital: level 0 near the main public lift lobby directly behind the Faith Centre.

Newark Hospital: Clean equipment storage area within Sconce ward.

Mansfield Community Hospital: Lindhurst ward store room. c. They contain:

King’s Mill Hospital: Adult, PREM and newborn trollies, sepsis and paediatrics boxes, resuscitation trolley support bags and outdoor first responder bags. Back up AEDs, manual defibrillators and portable suction units. Emergency lifting equipment.

Newark Hospital: Adult and PREM trollies (sepsis boxes on UCC).

Mansfield Community Hospital: Adult trollies and sepsis boxes.



d. Replacement of used sealed emergency equipment systems in the MEMD scheme

It is the responsibility of ward/dept staff to ensure the following actions are completed;

i. A used trolley/box/bag is immediately replaced by collecting a replacement from the relevant back-up point location.

ii. Any used disposable items are disposed of via the appropriate waste stream (DO NOT RETURN INDIVIDUAL USED ITEMS TO THE TROLLEY/BOX/BAG).

iii. Once the replacement is on the Ward/Dept, the used equipment must be sealed using the large red tag provided and immediately taken to the back-up point.

iv. Staff must immediately inform MEMD of the used equipment by telephoning ext. 3219.

v. Report your clinical area, date, time and used and new trolley/box/bag numbers. vi. The same procedure also applies to used paediatric and sepsis boxes; reseal

the boxes with the red used tag located inside the box prior to returning to the back-up point.

vii. KMH back up point room arrangement provides segregated new and used areas to guide staff and avoid cross contamination of clean, unused equipment; GREEN for new RED for used.

viii. Ensure equipment is placed in the appropriate area.

EMERGENCY RESUSCITATION TROLLEYS

a. Every adult ward/clinical area will be equipped with a sealed emergency resuscitation trolley containing essential equipment to commence and sustain CPR. All clinical areas with a duty of care to children will additionally have either a PREM trolley or a blue paediatric emergency box (please see appendices list for details of contents and locations of equipment or access via the Resuscitation Dept intranet site). Maternity areas will have the addition of a Newborn resuscitation trolley.

b. MEMD are responsible for the maintenance and tracking of equipment used in the resuscitation trolley, paediatric box and emergency bag schemes.

c. The Resuscitation Advisory Group is responsible for reviewing and updating all aspects relating to this area of care. Further information can be found in the Advisory Group Terms of Reference located on the Resuscitation Dept. intranet site.

d. In the event of a cardiac arrest, paediatric or neonatal emergency; the appropriate emergency trolley or box will be opened immediately and CPR commenced.

e. If additional equipment is needed, this can be located in the following areas:

Adult: Back up point sited on level 0 near the main public lift lobby directly behind the Faith Centre.

Paediatric: Emergency Dept, Ward 25, Theatres recovery.

Neonates: Sherwood Birthing Unit/Ward 14, NICU.

Newark Site: Urgent Care Centre, Adult & Paediatric e. Resuscitation Equipment Checking Procedure:

All resuscitation trolleys must be checked daily. For those in the MEMD replacement scheme this entails checking the green seal tag is intact & expiry date has not been reached. Other trolleys will require full contents and expiry date checks by staff.

Defibrillators readiness must be checked daily.

Suction Equipment must be checked daily for the presence of consumable items & receive a function test weekly.

Free standing oxygen cylinders in clinical areas must be accompanied by a non-rebreathe oxygen mask.

http://sfhnet.nnotts.nhs.uk/admin/webpages/default.aspx?recid=968




f. Procedure following use:

Decontamination of the trolley and contents initially by ward staff in accordance with the protocol outlined in the Resuscitation Equipment Guide.

Exchange of the trolley via the MEMD

Notify the MEMD Department a trolley has been opened on extension 3219 (24 hour answering service).

EXISTING RESUSCITATION TROLLEYS IN USE NOT COVERED BY THE MEMD REPLACEMENT SCHEME

a. Areas that implement the use of their own ward/dept resuscitation trolley are

individually responsible for its maintenance (ref sections 14.d and 14.e below).

b. A log will be maintained by the ward/dept recording daily maintenance checks. c. All trolleys will be stocked with the appropriate essential resuscitation

equipment at all times. d. For a list of neonatal resuscitation equipment see relevant appendix of the

Neonatal Resuscitation Guideline. e. The Resuscitation Officer (RO) as representative of the Resuscitation Advisory

Group will be responsible for updating the list as appropriate. 6.5 CARDIOPULMONARY ARREST IN SPECIAL CIRCUMSTANCES

a. Obstetric cardiac arrest: Staff will use the medical emergency telephone number 2222 to summon the obstetric emergency team in addition to the adult cardiac arrest team. The midwifery unit will be responsible for ensuring any additional equipment required to manage the situation is readily available and maternal CPR training is attended by staff.

b. Difficult Airway Situation: (Appendix X) Management of patients that are neck breathers3: Staff must ensure specialist airway equipment is readily available for all patients with tracheostomy and/or laryngectomy associated conditions. Specialist support and additional equipment can be accessed via the Critical Care Outreach Team (CCOT), the ENT Nurse Specialist using vocera, or the cardiopulmonary arrest team via the 2222 number. As an interim measure, in an emergency prior to arrival of the cardiopulmonary arrest team, an infant face mask is provided in the adult resuscitation box for the initial management of a patient that does not have a tracheostomy tube in situ and is unable to breathe through the mouth or nose.

c. Trauma Patients: Activation of the trauma team via switchboard using the 2222 emergency number ensures immediate attendance of all relevant personnel to manage a trauma situation in accordance with the Regional Trauma Protocol

d. Paediatric Patients: Staff will use the medical emergency telephone number 2222 clearly stating they need the paediatric emergency team. Paediatric resuscitation equipment is situated in all areas that routinely provide treatment and care to children.

3 NPSA Protecting Patients who are Neck Breathers 2005




6.6 POST RESUSCITATION CARE

a. The post resuscitation care guidelines incorporated in the Advanced Life Support Course or European Paediatric Advanced Life Support Course programme should be applied for those patients who survive a cardiopulmonary arrest.

b. Unstable critically ill patients will require provision of appropriate invasive monitoring of oxygenation, capnography for intubated patients, blood pressure, perfusion and urine output with reassessment of blood tests (e.g. full blood count, urea and electrolytes, blood glucose, cardiac enzymes, cross-matching, coagulation screening, calcium and magnesium level), chest radiography and twelve-lead electrocardiography, with continuous electrocardiograph monitoring and be considered for ongoing care in a critical care area (e.g. ICCU, CCU). Contact with the ICCU registrar will be required.

c. Once the patient is stabilised, transfer to the identified most appropriate specialised care area must be promptly instigated, with a continuance of non-invasive monitoring, as documented in the patient’s care management plan.

d. If the patient is not stable, do not transfer. This is of high importance for those patients requiring inter-hospital relocation.

e. The attending Specialist trainee Registrar in Medicine has the following responsibilities:

Ensure safe and prompt patient transfer.

Ensure a post resuscitation management plan of care is clearly documented in the patient’s medical records.

Ensure effective communication relating to the plan of care is established at a multi-disciplinary level.

Document the patient’s future resuscitation status and ensure this is communicated to the senior nurse on duty.

f. For those patients who are not transferred, ensure a written management plan identifies acceptable clinical observation parameters as outlined in the National Early Warning Scoring (NEWS) system4, with instruction for attending staff to trigger alert protocols as per The Observations and Escalation Policy for Adult In-Patients.

g. In the absence of an attending Specialist Trainee Registrar in Medicine, these responsibilities will rest with the most senior medical staff member in attendance at the time.

6.7 PATIENT TRANSFER

To facilitate safe transfer of a patient, it is necessary to ensure the following recommendations are adhered to: a. Suitable transport has been arranged b. The receiving area has been fully consulted. c. The patient’s relatives are informed. d. All necessary equipment required is available and in good working order. e. Sufficient quantities of any required medications are included. f. Appropriately trained personnel will escort the patient (paediatric retrieval team

may be warranted).

4 National Early Warning Score, the Royal College of Physicians 2012

https://www.resus.org.uk/resuscitation-guidelines/post-resuscitation-care/

https://www.resus.org.uk/resuscitation-guidelines/post-resuscitation-care/

https://www.resus.org.uk/resuscitation-guidelines/paediatric-advanced-life-support/

https://www.rcplondon.ac.uk/sites/default/files/documents/national-early-warning-score-standardising-assessment-acute-illness-severity-nhs.pdf





g. Medical notes, x rays, scan results etc are fully up to date and transferred.

(A police escort may be required in some emergency situations)

This aspect of the policy interfaces with the trust’s Escort Policy and the Paediatric Transfer Policy.

6.8 THE RESUSCITATION ADVISORY GROUP Terms of Reference

The Resuscitation Advisory Group’s actions are governed by adherence to national Resuscitation Council (UK) Guidelines. The Resuscitation Advisory Group Terms of Reference are accessible via the hospital intranet

Members: A list of current Resuscitation Advisory Group Members is accessible via the Trust intranet site.



http://www.resus.org.uk/pages/QSCPR_Acute.pdf




7.0 MONITORING COMPLIANCE AND EFFECTIVENESS

Minimum Requirement

to be Monitored

(WHAT – element of compliance or effectiveness within the

document will be monitored)

Responsible Individual

(WHO – is going to monitor this element)

Process for Monitoring

e.g. Audit

(HOW – will this element be monitored (method used))

Frequency of

Monitoring

(WHEN – will this element be monitored

(frequency/ how often))

Responsible Individual or Committee/

Group for Review of Results

(WHERE – Which individual/ committee

or group will this be reported to, in what format (eg verbal, formal report

etc) and by who)

Yearly completion of mandatory Basic Life Support training for all clinical staff groups.

Line Manager OLM/ESR compliance matrix. Yearly as part of

the appraisal process.

Trust board (monthly mandatory training compliance

reports).

Compliance to mandatory training

requirements (section 7.2, pages 18-20) for emergency response

team members

Service specific:

Resuscitation Training Manager - Adult & Paediatric Emergency

Teams

CCOT - ART Team

ED ANP Trauma Lead - Trauma Team

Practice Development Midwife -

Neonatal & Obstetric Teams

Resuscitation training manager monitoring 2222 call triggers via

switchboard and auditing attendees re. training

compliance. Any highlighted issues with training compliance and immediately escalated to the service lines responsible individual for management.

Ongoing as 2222 calls occur.

Deteriorating Patient Group (dashboard).

Local protocol in place to ensure departments

where 2222 calls are not routinely generated to manage events have staff compliant to the relevant mandated

emergency response team qualification.

Department managers/ service leads – Emergency department,

Cardiac Catheter Suite, Theatres, Intensive Critical Care Unit.

OLM/ESR compliance matrix comparison against training

needs identified. Ongoing.

Department managers/ Service Leads.


Minimum Requirement

to be Monitored

(WHAT – element of compliance or effectiveness within the

document will be monitored)

Responsible Individual

(WHO – is going to monitor this element)

Process for Monitoring

e.g. Audit

(HOW – will this element be monitored (method used))

Frequency of

Monitoring

(WHEN – will this element be monitored

(frequency/ how often))

Responsible Individual or Committee/

Group for Review of Results

(WHERE – Which individual/ committee

or group will this be reported to, in what format (eg verbal, formal report

etc) and by who)

All Cardiac Arrests will be audited by the

Resuscitation Department as outlined

in the Cardiac Arrest Governance Framework.

Resuscitation Officers.

Local audit of case notes, submission of relevant data to

the National Cardiac Arrest Audit database and local

information capture.

Ongoing audit, monthly reporting.

Deteriorating Patient Group, Patient Safety and Quality

Group, Harms Free Operational Group.

Daily checking of resuscitation equipment

in all wards and department when in use.

Department manager responsible for surety, checks can be

performed by any member of clinical staff.

Nursing metrics.

Monthly.

Deteriorating Patient Group.


8.0 TRAINING AND IMPLEMENTATION This information identifies resuscitation training standards for all Trust employees working clinically in accordance with their role, speciality and department. Levels of training Training activity necessary relating to resuscitation should be determined by:

Ensuring high level compliance to mandatory training levels as identified in this section and the mandatory training policy

Divisional level responsibility beyond mandatory training & through risk assessment to ensure a safe clinical environment is maintained (reference appendix XII)

Using this policy in conjunction with the Adult In-Hospital Escalation Policy, Maternity Escalation Policy , Paediatric Escalation Protocol to equip staff to prevent deterioration/cardiac arrest wherever possible when clinically appropriate to do so (a care & comfort focused end of life care pathway inclusive of a do not resuscitate decision may be in place)

Standard of Training The standards of training provided by SFHT are in accordance with RCUK Quality Standards for CPR Training & Practice and in support of the key priorities for managing deteriorating patients as outlined in NICE Guideline CG50. Resuscitation Training Available & Associated Competency Standards These can be found in the TED Training Manual under the Resuscitation Section for each course individually Training Provision Access to planned training course information & dates is via the Resuscitation Dept intranet The Resuscitation Department provide training opportunities in various ways:

Provision of nationally accredited courses

In-house scheduled training courses

At induction for clinical staff

Scheduled annual mandatory training sessions (access & information via the intranet)

Ad hoc group sessions by prior arrangement

Ward/Dept based CPR simulation by prior arrangement

E-learning programmes via Sherwood e-academy website

Training is also provided by clinical specialists/accredited instructors within their wards & departments with the support of the Resuscitation Dept on request.

Resuscitation Champions can provide in situ training

Neonatal & Obstetric Emergency skills training is provided by the Midwifery Educators and via the NLS course facilitated by the Resuscitation Dept.

Other related speciality specific clinical skills training is additionally provided by educational leads within various acute care areas of the trust.

Clinical staff who have attended an appropriate nationally recognised course or training in a previous post, within the last 12 months, may be exempt from training, provided documentary evidence is produced.

https://www.sfh-tr.nhs.uk/media/7253/lr-ted-mandatory-training-policy-v9-jun-19.pdf







https://www.nice.org.uk/guidance/cg50






8.1 MANDATORY TRAINING REQUIREMENTS All Clinical Staff All trust staff working in clinical areas as identified in the mandatory training policy must complete adult basic life support training. All staff with a duty of care to neonatal or paediatric patients must additionally complete neonatal/paediatric basic life support training. This training must be updated annually. New Staff All new Registered Nurses, Health Care Support Workers and Allied Health Professionals entering the Trust will receive their mandatory, competency assessed CPR training as part of their induction process. Non clinical staff will receive basic medical emergency advice on their Orientation Day Existing Staff Will access BLS training at their annual mandatory training event. This is booked via the Training, Education & Development intranet site Staff who do not achieve this must utilise a Resuscitation Champion or recognised ALS/EPALS/ILS instructor in their area, or attend an alternative training opportunity via the Resuscitation Dept. Neonatal training is accessed via Midwives, Paediatricians and the NLS Course Mandatory Medical Curriculum Training Provided for Junior Doctors Scheduled training activity exists annually to provide:

5th year medical students ILS Course

Foundation Year 1 doctors ILS Recertification Course

Foundation Year 2 doctors ALS course 8.2 EMERGENCY TEAMS Adult Medical Emergency/Cardiac Arrest Team (KMH & Newark) The teams consist of 2 tiers, which when combined create an effective emergency response resource. These are identified as:

Key roles essential to medical clinical management and/or leadership (bold font)

Support roles providing bedside clinical skills and/or assistance to the ward/dept environment & other patients while the emergency situation is in progress

Mandatory training levels have been mapped for each tier with acknowledgement of their level of clinical responsibility, using a multidisciplinary approach, and following consultation with team members where necessary to understand what their role most frequently entails.





Adult Medical Emergency/Cardiac Arrest Teams

*KMH Site: During the hospital out of hours periods a contingency plan will be activated on 8pm handover if ward 23 cover is required to release the senior nurse holding the emergency bleep to attend

Note: Newark emergency events usually involve patients that self-present, occasionally children

therefore team members in key roles require adult and paediatric training.

Paediatric Emergency Team

KMH Mandatory Training Level Hours Covered

Paediatric Registrar on call

EPALS or APLS 24/7

Paediatric FY2/ST1-3/GPSTR

PILS 24/7

Anaesthetic 2nd on call Completion of Core Anaesthetic training or equivalent

24/7

Ward 25 Nurse Coordinator

EPALS or APLS 24/7

Resuscitation Officer

EPALS or APLS

Mon-Fri 0900-1700 unless teaching commitments do not permit

KMH Mandatory Training Level

Recommended Training Level

Hours Covered

Medical Registrar ST3-7 on call

ALS 24/7

Medical CT1-2/FY2/Clinical Fellow (CF)

BLS ALS 24/7

Anaesthetic 1st on call Completion of IAC

ALS 24/7

Ward 23 Senior Nurse*

ALS 24/7

HOOP ALS 2000-0800

Resuscitation Officer

ALS Mon-Fri 0900-1700 unless teaching commitments do not permit

Duty Nurse Manager BLS ILS 24/7

Newark Mandatory Training Level Hours Covered

Medical Speciality Doctor on call

ALS 0800-1900

UCC Doctor ALS & EPALS 24/7

UCC Senior Nurse ILS &PILS 24/7


Neonatal Emergency Team


Paediatric Registrar ST3-7

NLS 24/7

Paediatric F2/ST1-3/GPSTR NLS 24/7

SBU Coordinator NLS 24/7

Obstetric Emergency Team


O&G Consultant Emergency Skills in

Obstetrics Course

0830-1830 on site then on call

O&G Registrar ST3-7 Emergency Skills in

Obstetrics Course 24/7

Obstetric CT 1-2/FY2/ST1-3

Emergency Skills in Obstetrics Course

24/7

SBU Coordinator NLS & Emergency Skills in

Obstetrics Course 24/7

Anaesthetist on call for Obstetrics

Completion of IAC 24/7

Note: NICU Nurse additionally attends if NICU workload permits

Trauma Team


Consultant ATLS/ETC Course 0800-2200

Emergency Care Middle Grade Doctor with designated team leader responsibilities

ATLS/ETC Course 24/7

Additional Team Members

Radiographer 24/7

2nd on-call Anaesthetist Completion of Core Anaesthetic training

24/7

Orthopaedic CT 1-2/FY2/ST1-3 on call

24/7

Surgical CT 1-2/FY2/ST1-3 on call

24/7

Resuscitation Officers

ATLS Course Observed

0900-1700 Monday-Friday unless teaching commitments do not permit

HOOHP ATLS Course Observed 2000-0800


Acute Response Team (ART)

KMH Mandatory Training Level

Recommended Training Level

Hours Covered

Medical Registrar ST3-7 on call

ALS 24/7

Anaesthetic 2nd on call

Completion of Core Anaesthetic training

AIM/ALS 24/7

Critical Care Outreach Nurse (CCOT)

Multifactorial Critical Care Skills

0745-2330

HOOHP

ALS (as required for role on adult CA Team)

2330-0745

9.0 IMPACT ASSESSMENTS

This document has been subject to an Equality Impact Assessment, see completed form at Appendix XIII

This document is not subject to an Environmental Impact Assessment 10.0 EVIDENCE BASE (Relevant Legislation/ National Guidance) AND RELATED SFHFT DOCUMENTS Evidence Base:

Resuscitation Council (UK) Quality standards for cardiopulmonary resuscitation and training – acute care (May 2017)

NICE Clinical Guideline 50 (July 2007) Recognition of Acutely Ill Patients in Hospital

NPSA Protecting Patients who are Neck Breathers 2005

National Early Warning Score (NEWS), Standardising the assessment of acute-illness severity in the NHS. The Royal College of Physicians 2012

Related SFHFT Documents:

Anaphylaxis Policy

ReSPECT Policy

The Observations and Escalation Policy for Adult In-Patients

ICCU Guideline – Post Cardiac Arrest Management

Maternity Early Warning Scores (MEWS)

Paediatric Emergency Guidelines

Paediatric Early Warning Score (PEWS)

Paediatric Transfer Policy

Guideline for Neonatal Resuscitation

Moving & Handling Policy

Mandatory Training Policy

Sharps & Needlestick Policy

Escort and Transfer Policy for Adult Patients

Medical Equipment User Training Policy



http://www.nice.org.uk/guidance/CG50/chapter/introduction

http://www.nrls.npsa.nhs.uk/resources/?EntryId45=59793













https://www.sfh-tr.nhs.uk/media/7197/hs-mhp03-moving-and-handling-policy-v9-feb-2018.pdf






11.0 KEYWORDS Emergency; Defibrillator; 2222; arrest; Trolley; MEMD; DNACPR; ReSPECT 12.0 APPENDICES

Appendix Ia Emergency Response Teams KMH

Appendix Ib Emergency Response Teams Newark Hospital

Appendix II Emergency/ Resuscitation Box Contents – Paediatric

Appendix III Resuscitation Trolley Contents List – Adult

Appendix IV PREM Trolley Contents

Appendix V Additional Equipment List

Appendix VI Number & Location of Paediatric Emergency Equipment

Appendix VII Number & Location of Cardiac Arrest Trolleys

Appendix VIII Newark Hospital Policy Variances

Appendix IX Mansfield Community Hospital Policy Variances

Appendix X Difficult Airway Algorithm

Appendix XI KTC Emergency Assistance Protocol

Appendix XII Guide to Staff Resuscitation Training

Appendix XIII Equality Impact Assessment Form


Appendix Ia – Emergency Response Teams KMH


Appendix Ib – Emergency Response Teams Newark Hospital


Appendix II

Paediatric Emergency Box Contents

Drugs Airway Equipment

Hypostop glucose gel

Disposable Bag/Valve/ Infant Mask and Child Mask

Adrenaline 1:1000 0.5ml ampoule Paediatric Yankauer Sucker

Glucagon 1mg

Paediatric Non-rebreathe oxygen mask and tubing

Tongue depressor

Oropharyngeal airways sizes:

000

00

0

1

Additional Equipment

1ml syringe x1

23g needle x1

25g needle x1


Appendix III

Adult Resuscitation Trolley

List of Contents

On the top of the Trolley

Sharps Bin Disposable Gloves Defibrillator (CD sized oxygen cylinder on the side of the trolley)

First Drawer

Defibrillator pads x2 packs

Cardiopulmonary Arrest Drugs

Adrenaline 1:10000 x 4

Calcium Chloride 10%/10mls

Amiodarone 300mg x 1

N/saline flush 10ml x 6 (prefilled syringes)

Tuff cut scissors (single use x 1)

Razor x 1

Adrenaline for Anaphalyxis

Second Drawer

ET Tube size 6

ET Tube size 7

ET Tube Size 8

Single use Laryngoscope mac 3

Single use Laryngoscope mac 4

20 ml syringe, luer slip BD

Magill Forceps, Marshall

Lubricating Gel, optilub 5g sachet

Catheter Mount, Intersurgical

Tape 100% cotton 12mm Spentex

Intubating Bougie (hollow to give 02 in emergency), 15ch

Oropharyngeal airway size 2 green

Oropharyngeal airway size 3 yellow

Oropharyngeal airway size 4 red

Nasopharyngeal Airways size 6.0 Rusch

Nasopharyngeal Airways size 7.0 Rusch

Airway Supraglottic I-Gel size 3



T Bag post op oxygenation device Intavent


Third Drawer

Resuscitator Manual Adult Size 5

Adult high concentration mask with tube, Intersurgical

Facemask aerosol adult with headstrap, Lifecare

Venturi valve 24% blue, Intersurgical

Venturi valve 28% white, Intersurgical

Venturi valve 35% yellow, Intersurgical

Venturi valve 40% red, Intersurgical

Venturi valve 60% green, Intersurgical

Suction Tubing 7mm x 3m, 2 fem/1male connector. Universal

Yankauer sucker Argyle

Suction catheter Argyle 12ch, white

Suction catheter Argyle 14ch, green

Facemask anaesthetic for neck breathers Timesco

Stethoscope, Lyall Willis

Tubing oxygen connecting crush resistant

Fourth Drawer

Syringe arterial blood gas preset vacutainer

Vacutainer holder for multi-sampling

Vacutainer Eclipse Multi-Sample Safety Needle, 21x1.5"

IV Cannula Venflon 14g, orange

IV Cannula Venflon 16g, grey

IV Cannula Venflon 18g, green

IV Cannula Venflon 20g, pink

IV Cannula Venflon 22g, blue

Bandage light support 5cm x 4.5m, Hospitlite

Drug additive labels x4

Skin-prep wipes 2% Chlorhexidine

Needle 21g x 1.5" green Agani

Needle 23 g x 1 1/4" blue Agani

Needle blunt filter

Syringe hypodermic luer slip 2ml BD Plastipak




Cotton wool balls, sterile large pack of 5

Non woven swabs 7.5x7.5 4ply in 5's

Tourniquet single use stretch Vacutainer

IV dressing 6x7cm ported cannula

Normal Saline Ampoules 10mls X 10

Water Ampoules 10 mls X 2

Assorted Blood Bottles (1 of each colour - Blue, Gold, Grey, Lavender and Pink)

Holder/Adapter for Blood Collection Vacutainer

Pressure Infusor Bag, 1000ml, Lang Skintact

Tape medical adhesive plastic Claripore 5cm x 9.14m


5th Drawer

I.V Fluids

0.9% Sodium Chloride 500 mls x 2

0.9% Sodium Chloride 1000 mls x2

10% dextrose 500mls x 1

Hartmans solution 1000 mls x 2

Admin set gravtiy blood Baxter x2

Admin set gravity solution Carefusion x2


Appendix IV PREM TROLLEY CONTENTS

Drawer 1 – Pink Airway & Breathing

Mask 0 and 1 round 1 Laryngoscope handle, with batteries & Miller 0 blade 1 Laryngoscope handle, with batteries & Miller 1 blade 1 OP airway 000, 00 and 0 1 ET tubes un-cuffed 2.5, 1 Micro cuffed ET tube 3.0, 3.5 1 I-Gel 1, 1½ 1 Paediatric Magill forceps 1 Stylet 6F 1 Suction catheter 6F, 8F 3 Paediatric Yankauer 1 Lubricant gel 1 Tongue depressor 1 Cotton Tape 1

Drawer 2 - Pink Circulation

Cannula 24g (yellow) 6 Butterfly 23g, 25g 2 Mediswab 5 Needles orange, green, blue and purple 3 N/Saline 20 ml 3 Syringes: 1 ml 5 2 ml 5 5 ml 5 10 ml 5 50 ml 1 Gauze &Tape 1 3 way tap/extension 2 Scissors 1 Tourniquet 1 IV Cannula fixing 3 Blood Gas syringe 2

Pink Airway

Drawer

Birth to 8kg

Pink Circulation Drawer Birth to 8kg

Yellow Airway Drawer 8kg to 14kg

Yellow Circulation Drawer 8kg to 14kg

Green Airway Drawer 14kg to 24kg

Green Circulation Drawer 14kg to 24kg

Blue Airway

Drawer

Above 24kg

Blue Circulation Drawer Above 24kg

White support drawer All weights


Drawer 3 - Yellow Airway & Breathing Mask 1 and 2

1

Laryngoscope handle, with batteries & Miller 1 blade 1 Laryngoscope handle, with batteries & Miller 2 blade 1 OP airway 0 and 1 1 Microcuffed ET tubes 3.5, 4.0, 4.5 1 I-Gel 1½, 2 1 Stylet 6F 1 Child Magill forceps 1 Suction catheter 8F, 10F 3 Paediatric Yankauer 1 Lubricant gel 1 Tongue depressor 1 Cotton Tape 1

Drawer 4 - Yellow Circulation

Cannula 24g (yellow) 6 Cannula 20g, 22g 3 Butterfly 21g, 23g, 25g 2 Mediswab 5 Needles orange, green, blue and purple 3 N/Saline 20 ml 3 Syringes: 1 ml 5 2 ml 5 5 ml 5 10 ml 5 50 ml 1 Gauze & Tape 1 3 Way tap/extension 2 Scissors 1 Tourniquet 1 IV Cannula fixing 3 Blood gas syringe 2

Drawer 5 - Green Airway and Breathing

Mask 1 and 2 1 Laryngoscope handle, with batteries & Miller 2 blade 1 Laryngoscope handle, with batteries & Mac 2 blade 1 OP airway 1 and 2 1 Microcuffed ET tubes 4.0 4.5, 5.0, 5.5 1 I-Gel 2, 2½ 1 Child Magill forceps 1 Stylet, 10F 1 Suction catheter 8F, 10F 3 Paediatric Yankauer 1 Lubricant gel 1 Tongue depressor 1 Cotton Tape 1

Drawer 6 - Green Circulation

Cannula 24g (yellow) 6 Cannula 18g, 20g, 22g 3 Butterfly 21g, 23g 2 Mediswab 5 Needles orange, green, blue and purple 3 N/Saline 20 ml 3 Syringes: 1 ml 5 2 ml 5 5 ml 5 10 ml 5 50 ml 1 Gauze & Tape 1 3 Way tap/extension 2 Scissors 1 Tourniquet 1 IV Cannula fixings 3 Blood Gas Syringe 2


Drawer 7 - Blue Airway & Breathing Mask 2 and 3 1 Laryngoscope handle, with batteries & Mac 2 blade 1 Laryngoscope handle, with batteries & Mac 3 blade 1 OP airway 2 and 3 1 Microcuffed ET tubes 5.5, 6, 6.5, 7 1 and 7.5 standard cuffed 1 I-Gel 2½, 3 1 Adult Magill forceps 1 Stylet 10F,14F 1 Suction catheter 12F, 14F 3 Adult Yankauer 1 Lubricant gel 1

Drawer 8 - Blue circulation Cannula 24g (yellow) 6 Cannula 16g, 18g, 20g 3 Butterfly 19g, 21g 2 Mediswab 5 Needles orange, green, blue and purple 3 N/Saline 20 ml 3 Syringes 1 ml 5 2 ml 5 5 ml 5 10 ml 5 50 ml 1 Gauze & Tape 1 3 way tap/extension 2 Scissors 1 Tourniquet 1 IV Cannula fixing 3 Blood Gas syringe 2

Support Drawer NG tube 6F, 8F, 10F, 12F,14F, 16F Chest drain 10F, 12F, 16F,20F, 24F,28F, 32F Bougie Size 5ch, 10ch, 15ch Capillary tube 1 box Laminated PALS and anaphylaxis algorithm

1

Ph test strips Child Bag, Valve Mask 1 Adult Bag, Valve Mask 1 Child Nebuliser Mask 1 Adult Nebuliser Mask 1 Child Non-Rebreathing Mask 1 Adult Non-Rebreathing Mask 1 Red Used Seal 1


Appendix V

Additional Equipment

Defibrillator

(If mains powered ensure that the defibrillator is plugged in to charge the battery at all times when not in use.) Manual defibrillators: Defibrillator Pads X2 Packs sealed (Not Expired)

ECG Electrodes X 1 Pack (Not Expired) Spare paper rolls X 2

*Automated defibrillators: AED pads X 2 Packs sealed (Not Expired) (AED) Pair of scissors Razors X2 *Note: Resuscitation trolleys contain the AED items in the top drawer

Portable suction unit (if applicable) Suction Tubing

Attached to the machine Yankauer Note: Resuscitation trolleys contain these suction items and soft suction catheters in the 3rd drawer


Appendix VI

Number & Location of Paediatric Emergency Equipment August 2015

Location No Paediatric

Boxes/ PREM

Trolley

Paediatric

Loose Drug

Rolls

King’s Mill Hospital

Emergency Dept Prem Trolley 2

Ward 25 Prem Trolley 2

Level 0 (backup point) 2

Day Case Recovery Prem Trolley +1

Theatre Recovery Prem Trolley

Main X-Ray 1

MRI 1

Ward 14 1

Ward 25 Prem Trolley

KTC

Level 0 King’s Treatment Centre Reception 1

Level 0 Clinic 5 1

Level 1 Clinic 7 1

Clinic 11 1

Level -1 Physiotherapy Pool 1

Level 1 Children’s Centre 1

(SBU) Sherwood Birthing Unit

5

(SBU) Sherwood Birthing Unit - Theatre 1

Maternity Ward 1

Women’s Out Patient Department 1

24 Hour Primary Care 1

Newark Hospital

UCC Prem Trolley

Bramley Unit 1

Currently 24 Paediatric boxes in total for servicing the scheme


Appendix VII

Number & Location of Cardiac Arrest Trolleys

Area No of Trolleys Area

No of Trolleys Area

No of Trolleys

Newark Hospital

King's Mill Hospital

King's Mill Hospital

Sconce 1 Main X-Ray Department 1 Ward 31 1

Minster

MRI Department 1 Ward 32 1

Endoscopy 1 Cardiac Catheter

Suite 1 Ward 33 1

Fernwood 1 ICCU 2 Ward 34 1

OPD / X-Ray 2 EAU A+B 2 Ward 35 1

Sherwood Women's Suite 1 Renal Unit 1 Ward 36 1

Eastwood Day Centre 1 Occ. Health 1 Ward 41 1

Byron House 1 Ward 11 1 Ward 42 1

CT Scan 1 Ward 12 1 Ward 43 1

Back up point (Sconce) 2 Ward 14 1 Ward 44 1

Mansfield Community

Hospital

SBU 1 WTC 1

Lindhurst 1 Maternity Ward 1 Ward 51 1

Oakham 1 Ward 21 1 Ward 52 1

Chatsworth 1 Ward 22 1 Ward 53 1

Tony Hughes 1 Ward 23 2 Ward 54 1

Sherwood Rehabilitation

Centre 1 Ward 24 1 GU Medicine 1

Back up point (Lindhurst) 1 Ward 25 1 Main Theatres 4

Theatre 1 Education

Centre 2 Back up point

(level 0) 12


Appendix VIII

Newark Hospital Policy variances for the Newark Hospital site are as follows:

1. Procedure for Cardiopulmonary arrest

1.1. Dial 2222 to initiate the alert procedure.

2. The Cardiopulmonary arrest Team Team members are activated by dialling 2222.

On duty designated medical staff grade (8am – 7pm)

On duty designated UCC Doctor (24 hr)

On duty designated cardiopulmonary arrest nurse (UCC– 24hr)

On duty Anaesthetist/ODP if available to attend (Mon-Fri Theatre hours)

Admin Sister (this is a supporting role to advanced-level trained staff -24 hr)

Porter

Note: In the event of self-presentation of a paediatric emergency from within the community, the same team members will be activated.

3. Resuscitation Trolleys

3.1. If additional equipment is needed this can be located in the following areas:

Adult Sconce Ward Paediatric: Minor Injuries Unit (MIU)

3.2 Staff must collect a replacement trolley from the back up point immediately post event

3.3 The sealed, used resuscitation trolley must be taken to the back up point

immediately following use (staff must ensure the used trolley has been reported to MEMD at the same time)

3.4 Staff must immediately report the used trolley to MEMD on ext: 3219 (24hr) stating

name, date, time, location, new & used trolley MEMD numbers.

4 Site Coverage

The cardiac arrest team will additionally provide support beyond the general areas to:

Byron House Sherwood Women’s Centre The Fernwood Unit


Appendix IX

Mansfield Community Hospital

Policy variances for the Mansfield Community Hospital site are as follows:

1. Procedure for Cardiopulmonary arrest 1.1 When an arrest occurs a member of staff will take the resuscitation trolley, the

Automated External Defibrillator (AED), oxygen and suction equipment to the patient and commence CPR.

1.2 AED’s are situated on Chatsworth, Oakham and Lindhurst Wards and the Tony Hughes Treatment Centre

1.3 A further member of staff will telephone 9,999 stating: I. Hospital and Ward location II. Nature of emergency i.e. cardiopulmonary arrest

III. Request an ambulance to attend IV. Ring Helpdesk and request Porter to open front doors if out-of-hours for

ambulance staff access Weekend/Bank Holidays-Day Time:

As above Night Time

As above.If required telephone the “buddy” ward (as identified) and request that they immediately:

I. Send assistance to the ward. II. Contact the helpdesk (ext.3005) stating a porter is required to open the main

entrance doors to the hospital. Buddy Ward Pairings:

Lindhurst and Oakham

2. Resuscitation Trolley 2.1 If additional equipment is needed this can be located on Tony Hughes Treatment

Centre and Chatsworth Rehabilitation Suite 2.2 Staff must immediately take the used trolley to the back-up point on Lindhurst Ward

and replace it with the spare. 2.3 MEMD must be informed immediately by telephoning ext: 3219 and reporting name,

date, location, used and new trolley numbers.

3. Automated External Defibrillators (AED)

3.1 Following use it is the responsibility of the senior nurse on the ward where the AED has been deployed to:

Report the use of the AED to MEMD on extension 3219 immediately after the event.

Ensure the AED is returned to its original location

AED Pads are now located in the resuscitation trolley


APPENDIX X – DIFFICULT AIRWAY ALGORITHM 18th July 2014 AGREED PLAN FOR ADULT CARDIAC ARREST AIRWAY MANAGEMENT Current Advanced Life Support Guidelines: The tracheal tube has generally been considered the optimal method of managing the airway during cardiac arrest. But there is evidence that, without adequate training and experience, the incidence of complications, such as unrecognised oesophageal intubation is unacceptably high.

Prolonged attempts at tracheal intubation are harmful; the cessation of chest compressions during this time will compromise coronary and cerebral perfusion. Several alternative airway devices have been considered for airway management during CPR. Most researchers have studied insertion and ventilation success rates. The Supraglottic Airway Devices are easier to insert than a tracheal tube and, unlike tracheal intubation, can generally be inserted without interrupting chest compressions.

There are no data supporting the routine use of any specific approach to airway management during cardiac arrest. The best technique is dependent on the precise circumstances of the cardiac arrest and the competence of the rescuer. Dr Som Sarkar Consultant in Anaesthesia & ICM

http://www.resus.org.uk/pages/alsFacts.pdf


Algorithm for Airway Assistance at Sherwood Forest Hospitals

CARDIAC ARREST CONFIRMED 2222 CALL PUT OUT

BASIC / ADULT LIFE SUPPORT IN PROGRESS

DIFFICULTY IN MAINTAINING ADEQUATE VENTILATION WITH

BAG AND MASK WITH 15L/MIN OXYGEN

ANAESTHETIST PRESENT

AIRWAY ASSESSMENT MANAGEMENT: LMA, ETT or CONTINUE AMBUBAG/MASK

ANAESTHETIST NOT PRESENT OPTIMISE AIRWAY JAW THRUST SUCTION AIRWAY AIRWAY ADJUNCTS (NASAL/GUEDEL)

ALS TEAM MEMBER IF PRESENT ATTEMPT LMA INSERTION IF

COMPETENT

REQUIRES INTUBATION WITH ANAESTHETIC

DRUGS OR DIFFICULT AIRWAY

CARDIAC ARREST ET INTUBATION:

ASK ANAESTHETIST

IF ODP REQUIRED

NO ODP REQUIRED

ODP REQUIRED CALL 2222

‘EMERGENCY ODP TO WARD …….’


Note: Variations of the above protocol are in use throughout KTC to reflect the nearest location for depts of a resuscitation point

Appendix XI


APPENDIX XII

Guide to Appropriate Resuscitation Training for Staff in Support of Identified Mandatory Training

Department/Speciality Grade Recommended

Training Level

Emergency Department

(ED)

Band 5 RN ILS & PILS AIM

Band 6/7 RN ALS, ATLS, AIM

EPALS as identified in

ED policy/protocol

ANP/ACP ALS EPALS ATLS

Emergency Assessment

Areas

Band 6/7 RN ALS

CCrISP observer

ATLS observer,

AIM ILS

Band 5 RN AIM ILS

Healthcare Assistants AED HCA AIM

Ward 23 Cardiac Arrest Bleep

Holders

ALS (mandatory)

All RN Staff (non bleep

holders)

ILS AIM

Healthcare Assistants HCA AIM

Cardiac Catheter Suite All RN’s ALS AIM

Physiologists AED AIM


Theatres All RN Staff AED AIM

ODP’s ILS PILS AIM

Non registered staff HCA AIM

APPENDIX XII


ITU & Critical Care RN AED ILS AIM

Outreach Team (CCOT) ALS AIM

Paediatrics Ward 25

Senior RN APLS/EPALS

RN PILS AED

Non registered staff AED

Midwifery Sherwood Birthing Unit, Maternity Ward, ANC/PDC

All RM AED Mat AIM

Senior RM NLS Mat AIM

SBU Coordinator (RM) ALSO Mat AIM

All RN Theatre Staff AED AIM

Neonatal Unit All RN/RN grades NLS

Out- Patient services areas

All RN Staff AED AIM PILS


Therapy Sevices AHP’s-In high risk areas e.g. Critical Care, Hydrotherapy pool & staff providing on-call services for acute patients

AED AIM

Assistants HCA AIM

Radiology AHP’s & Radiologists in high risk areas

AED, Anaphylaxis

AHP’s nuclear medicine & cardiac stressing

ILS Anaphylaxis

AHP, Radiologists, nursing and imaging assistants

AED, Anaphylaxis

Cardio-Respiratory Clinical Scientific Officer’s ILS PILS

All General Wards/Departments

All RN Staff AED AIM

Healthcare Assistants & Assistant Nurse Practitioners

AED HCA AIM

Newark Hospital Senior RN Ward & MIU staff ILS /AED, AIM

Acute Care Practitioners, ENP’s

ALS, PILS

Mansfield Community Hospital

RN’s & AHP’s AED, AIM

Healthcare Assistants HCA AIM


Divisional Guide to Resuscitation Training Needs – Medical Staff

Department/Speciality Grade Recommended Training Level

Medicine* FY1 Clinical Fellow

AIM, ILS

FY2, Core Trainees, Specialist Trainees GPVTS Senior Clinical Fellow

ALS - Mandatory for CA bleep

holders

SpR S/G M/G ALS- Mandatory for CA bleep

holders Consultant, Assoc. Specialist

ALS

Surgery* FY1 Clinical Fellow

AIM ILS,


ATLS

SpR & S/G M/G ATLS, CCrISP

Consultant, Assoc. Specialist

ATLS, CCrISP

Anaesthetics/ICCU

FY1 Clinical Fellow

AIM, ILS,


ALS & ATLS

SpR S/G M/G ALS, ATLS, APLS/EPALS


ALS & ATLS, APLS/EPALS

Urgent & Emergency Care

FY1 Clinical Fellow

AIM, ILS,


ALS

SpR S/G M/G ALS, ATLS, APLS/EPLS


ALS, ATLS, APLS/EPLS


Women & Children's Obstetrics & Gynaecology

FY1 Clinical Fellow

AIM, ILS,


ILS & ALSO

SpR S/G M/G ALSO/MOET


ALSO/MOET

Paediatrics

FY1 Clinical Fellow

AIM, ILS & PLS/PILS


PLS/PILS

SpR S/G M/G APLS/EPLS & NLS


APLS/EPLS & NLS

Diagnostics & Outpatients

All grades AED, ILS, PILS

* Low risk areas recommended training: AED/ILS for all staff groups

The remainder of non-clinical staff employed within the Trust are encouraged to attend basic life support training.


Abbreviations List

Course Abbreviations Clinical Staff Abbreviations

ILS Immediate Life Support RN Registered Nurse

ALS Advanced Life Support RM Registered Midwife

ATLS Advanced Trauma Life Support

AHP Allied Health Professional

PLS Paediatric Life Support ODP Operating Department Practitioner

ETC European Trauma Course ANP Advanced Nurse Practitioner

PILS Paediatric Immediate Life Support

ACP Advanced Care Practitioner

ENP Emergency Nurse Practitioner

EPLS European Paediatric Life Support

SG Staff Grade

APLS Advanced Paediatric Life Support

MG Middle Grade

ALSO Advanced Life Support Obstetrics

SpR Specialist Registrar

MOET Managing Obstetric Emergencies & Trauma

GPVTS General Practice Vocational Training Scheme

NLS Neonatal Life Support ANP Advanced Nurse Practitioner

AED Automated External Defibrillator training

ACP Advanced Care Practitioner

AIM Acute Illness Management

Mat AIM Maternal Acute Illness Management

HCA AIM

Healthcare Assistant Acute Illness Management Course

CCrISP Care of the Critically Ill Surgical Patient


Appendix XIII – Equality Impact Assessment Form

Guidance on how to complete an EIA

Sample completed form

Name of service/policy/procedure being reviewed: Resuscitation Service; CPR policy

New or existing service/policy/procedure: Existing

Date of Assessment: 03/11/2017

For the service/policy/procedure and its implementation answer the questions a – c below against each characteristic (if relevant consider breaking the policy or implementation down into areas)

Protected

Characteristic

a) Using data and supporting information, what issues, needs or barriers could the protected characteristic groups’ experience? For example, are there any known health inequality or access issues to consider?

b) What is already in place in the policy or its implementation to address any inequalities or barriers to access including under representation at clinics, screening?

c) Please state any barriers that still need to be addressed and any proposed actions to eliminate inequality

The area of policy or its implementation being assessed:

Race and Ethnicity:

None None None

Gender:

None None None

Age:

None None None

Religion: None None None

Disability:

None None None

Sexuality:

None None None

Pregnancy and Maternity:

Pregnant staff members will require assessment of the potential risks or impacts regarding the provision of chest compressions and an agreement reached between the affected staff member and their line manager as to their role in cardiac arrest events.

No change is required as there are alternative roles that can be undertaken by affected staff members to support patient care.

Not required.

http://sfhnet.nnotts.nhs.uk/content/showcontent.aspx?ContentId=49233



Gender Reassignment:

None None None

Marriage and Civil Partnership:

None None None

Socio-Economic Factors (i.e. living in

a poorer neighbourhood /

social deprivation):

None None None

What consultation with protected characteristic groups including patient groups have you carried out?

No consultation undertaken.

What data or information did you use in support of this EqIA?

As far as you are aware are there any Human Rights issues be taken into account such as arising from surveys, questionnaires, comments, concerns, complaints or compliments?

No.

Level of impact From the information provided above and following EqIA guidance document (click here), please indicate the perceived level of impact: Low Level of Impact. For high or medium levels of impact, please forward a copy of this form to the HR Secretaries for inclusion at the next Diversity and Inclusivity meeting.

Name of Responsible Person undertaking this assessment: Scott Slater

Signature:

Date: 03/11/2017


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