Contents1. Introduction.........................................................................................................................................12. Rationale..............................................................................................................................................13. Aims and objectives.............................................................................................................................24. Policy statement..................................................................................................................................25. Scope...................................................................................................................................................46. Roles and responsibilities....................................................................................................................4

6.1 Clinical Governance Group (CGG).............................................................................................46.2 Responsibilities of managers....................................................................................................56.3 Responsibilities of staff.............................................................................................................5

Policy title Resuscitation Policy

Policy reference number CG007

Lead policy author/s Adapted by Bob Pearcey

Clinical Trainer

Nicola Rocca, Team Leader, Disabled Children’s Nursing Team

Accountable director Simon James Associate Director of SEND

Approved by: Clinical Governance Group

Date:

Ratified by: Achieving for Children’s SLT

Date:

Equality impact statement A screening assessment has been undertaken to ensure that equality is promoted and there is no discrimination in view of race, disability, age, gender, sexual orientation or religious belief.

Equality impact statement Yes

Implementation date July 2016

Next review date July 2019

6.4 Non-Achieving for Children employed and contracted staff.....................................................57. Training................................................................................................................................................58. Implementation...................................................................................................................................69. Audit and review.................................................................................................................................610. Procedures and guidance....................................................................................................................6

10.1 In the event of an emergency, staff should carry out the following actions:........................610.2 Do not attempt resuscitation (DNACPR/ADRT) and refusal to advance decisions to refuse

(ADRT) treatment guidelines for children and young people under AfC...............................610.3 Initiation of the resuscitation and summoning of help.........................................................710.4 Paediatric resuscitation........................................................................................................710.5 Non-Achieving for Children premises...................................................................................710.6 Out of hours..........................................................................................................................8

11. Resuscitation care................................................................................................................................811.1 Anaphylaxis for adults and paediatrics.................................................................................811.2 Airway management.............................................................................................................811.3 Defibrillators: automated external defibrillator (AED)..........................................................911.4 Oxygen..................................................................................................................................911.5 Drugs.....................................................................................................................................9

12.0 Standards in clinical areas...................................................................................................................912.1 Ensuring resuscitation equipment is maintained................................................................1012.2 Document equipment checks.............................................................................................1012.3 Cross infection....................................................................................................................1012.4 Manual handling.................................................................................................................10

13. Reference..........................................................................................................................................11Appendix 1 – Adult basic life support.............................................................................................................12Appendix 2 – Adult choking treatment...........................................................................................................13Appendix 3 - Paediatric basic life support......................................................................................................14Appendix 4 – Paediatric choking treatment...................................................................................................15Appendix 5- Anaphylaxis................................................................................................................................16Appendix 6-Basic life support for babies and children with a tracheostomy..................................................17Appendix 7-Compression Only Basic Life Support...........................................................................................18

Membership of policy development group....................................................................................................19

1. IntroductionThe policy is based on the Resuscitation Council (UK) Guidelines (2015) which have been accredited by the National Institute for Health and Care Excellence (NICE. It is also based on guidance from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing (previously known as the ‘Joint Statement’) October 2014 – 3rd Edition. It is compliant with the NHS Litigation Authority Risk Management Standards (2010), the Health Service Circular (HSC) 2000/028 and the Mental Capacity Act (2005). It sets out the requirements and related standards Achieving for Children (AfC) will adopt.

Chief executives are asked to ‘ensure that appropriate resuscitation policies which respect children and young people's rights are in place, understood by all relevant staff and accessible to those who need them, and that such policies are subject to appropriate audit and monitoring arrangements.’ (HSC 2000/028: Resuscitation Policy).

AfC has an obligation to provide an effective and efficient resuscitation service and to ensure that staff receive annual training and regular updates to maintain competence appropriate to their role.

AfC is committed to promoting safety at all times. Professionally qualified nursing staff and support staff working in premises where children are treated, will be able to provide a minimum standard of basic life support (BLS), also known as cardio pulmonary resuscitation CPR).

Professionally qualified nursing staff and support staff caring for children in their own homes or in the special school setting, will be competent to provide BLS until the emergency services arrive. All allied health professionals and non-professionally qualified staff working in higher risk clinical services will also be competent to provide BLS.

It is essential that this policy is clearly explained in a timely manner to children, young people and their carers in a language and format that they can easily understand. This may necessitate the use of language support services. Whilst resuscitation is an emergency procedure and such explanation may not be possible, it is nevertheless considered essential to keep children, young people, their parents and their carers informed. This information should be conveyed in a culturally sensitive way taking into account the different spiritual and religious beliefs in our local community.

2. Rationale This policy is applicable to all AfC staff for the management of children and young people, carers and families, visitors and staff undergoing cardio-pulmonary arrest both in AfC premises and in the community.

The Resuscitation Council (UK) states: “It is possible that if a rescuer performs a procedure negligently others may, additionally or alternatively, be pursued for damages in respect of the injuries that the casualty suffers. In this context, there is a potential liability for those who train resuscitation techniques, those who provide and maintain resuscitation equipment and those who administer the system under which rescuers operate.”

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Under the Care Quality Commission (CQC) Fundamental Standards, Regulation 12 Safe Care and Treatment, it is stated that: ‘The intention of this regulation is to prevent people from receiving unsafe care and treatment and prevent avoidable harm or risk of harm. Providers must assess the risks to people’s health and safety during any care or treatment and make sure that staff have the qualifications, competence, skills and experience to keep people safe.

Providers must make sure that the premises and any equipment used is safe and where applicable, available in sufficient quantities.

Providers must prevent and control the spread of infection. Where the responsibility for care and treatment is shared, care planning must be timely to maintain people’s health, safety and welfare.’

3. Aims and objectives The aims of this policy are to:

ensure that AfC standards around BLS are vigorously embedded throughout the health and support teams in the organisation

ensure that employees of AfC who provide care for children and young people are trained in BLS and where necessary trained in use of automated external defibrillators (AED)

reduce mortality and morbidity of those children and young people who have suffered a respiratory or cardiac arrest

reduce mortality and morbidity of those adults who have suffered a respiratory or cardiac arrest on AfC premises

provide staff with clear direction and guidance on their professional and contractual obligations in relation to BLS training.

AfC will ensure that every person will receive the highest standard of care in the event of a medical emergency or cardiopulmonary arrest occurring on its premises. The care will be delivered by staff trained to current and clinically evidenced standards for their role, to achieve the optimum outcome for each individual concerned.

4. Policy statement Cardiac arrest in children often occurs for very different reasons to adults.

Primary cardiac arrest (when the heart stops first) is common in adults and is often related to disease processes such as cardiovascular disease. Conversely, children tend to suffer secondary cardiac arrest, where the heart stops as a result of other illness or injury, which is often respiratory in nature.

AfC employees who provide care for children and young people must be fully competent to a minimum of adult and paediatric basic life support (PBLS). They may also undertake further advanced life support training as their role and job descriptions dictate, identified by the training needs analysis and agreed with their managers.

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All training will be booked through the training department, and attendance overseen by line managers, ensuring all mandatory training is undertaken at the correct time.

Healthcare workers who may be expected to respond to an adult or paediatric cardiac arrest should be fully conversant with the specific guidelines.

A consensus view, based on studies of comparable providers, suggests that as a minimum clinicians should have refresher training in BLS annually, and where appropriate, advisory external defibrillation (AED).

This resuscitation policy fully supports the recommendations for clinical practice and training in cardiopulmonary resuscitation published by the Resuscitation Council (UK) (2015) and has been constructed to promote compliance with the NHSLA Risk Management Standards (NHSLA, 2012/13).

In addition, it addresses issues raised in the following legislation:

Data Protection Act 1998

Data protection issues have been considered with regard to this policy. Adherence to this policy will therefore ensure compliance with the Data Protection Act 1998 and internal data protection policies.

Health and Safety Act 1974

Health and safety issues have been considered with regard to this policy. Adherence with this policy will therefore ensure compliance with health and safety legislation and internal health and safety policies.

Mental Capacity Act 2005

The Mental Capacity Act 2005 provides a statutory framework to empower and protect vulnerable people who are not able to make their own decisions. It makes it clear who can take decisions, in which situations and how they should go about this. It enables people to plan ahead for a time when they may lose capacity. Guidance set out in the act should be considered when implementing this policy.

Human Rights Act 1998

The Human Rights Act 1998 has been considered with regard to this policy. Proportionality has been identified as the key to human rights compliance. This means striking a fair balance between the rights of the individual and those of the rest of the community. There must be a reasonable relationship between the aim to be achieved and the means used.

Equality Act 2010

The Equality Act 2010 has been considered with regards to this policy. Adherence to this policy means that AfC will eliminate discrimination on the grounds of:

age being or becoming a transsexual person being married or in a civil partnership being pregnant or having a child

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disability race including colour, nationality, ethnic or national origin religion, belief or lack of religion/belief sex sexual orientation

5. ScopeThis policy applies to all AfC employees who provide care for children and young people. Training and practice are necessary to acquire and maintain skill in resuscitation techniques. Resuscitation skills decline rapidly and regular updates and retraining using mannequins is necessary to maintain adequate skill levels.

6. Roles and responsibilitiesDuties in respect of the requirements of this document are as follows.

The AfC Board has overall responsibility for procedural documents and delegates responsibility as appropriate

The Chief Executive has the responsibility to ensure that the requirements of the Health Service Circular (HSC 2000/028) for resuscitation services are met within AfC.

6.1 Clinical Governance Group (CGG)

The Clinical Governance Group is responsible for ensuring AfC maintains compliance with all the requirements of The Health and Social Care Act 2008, and where there are gaps, develops an action plan for achieving delivery of care to the range of standards.

Ensures all AfC employees who provide care for children and young people have attended the required mandatory BLS training annually.

Ensures compliance with the Health Act, CQC regulations and all related standards.

Oversees the revision, development, ratification, implementation and monitoring of all related policies and protocols.

Provides reports (following request) to the board.

Agrees and monitors attendance at the training programme for staff – including mandatory and statutory training for BLS.

Agrees any related audit programme, monitor outcomes of audits and ensure recommendations and actions are taken.

Provides a forum for discussion and review for resuscitation related activity.

Considers resuscitation issues and the perceived and associated risks, and if required escalates onto the risk register.

Monitors reported and related incidents and oversees the development of appropriate action plans where required.

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Supports the learning and cascading of any root cause analysis or investigations to the wider organisation.

6.2 Responsibilities of managers

Managers of personal care or health-related services are responsible for ensuring that all staff are familiar with BLS control policies, and that this information is given to all new staff on induction (where applicable).

Managers within AfC are responsible for raising awareness of BLS, implementing where necessary in accordance with legislation, organisational policy and best practice, and monitoring compliance and application of learning.

Managers are responsible for coordinating and supporting the release of their staff to ensure they can attend the required training.

Managers must ensure their staff report all related incidents in a timely manner. Clinically related incidents are captured by the Head of Integrated Service for Children with Disabilities and escalated accordingly.

6.3 Responsibilities of staff

Staff must adhere strictly to the BLS and related policies.

AfC employees who provide care for children and young people must comply with BLS standards during any resuscitation event.

Staff are responsible for booking onto, and attending, all mandatory training requirements.

6.4 Non-Achieving for Children employed and contracted staffAgency or locum staff are not included in AfC BLS training programme. Therefore they, or the agency employing them, are individually responsible for remaining appropriately trained for the role in which they are employed. As agreed by the pan London Patient Agency Supply Agreement (PASA). However, bank staff who are directly employed by AfC are covered by this Resuscitation policy and will have access to AfC training programme and be expected to maintain their competence.

7. Training Training for BLS will form part of the core mandatory requirements for all staff including bank in the Integrated Service for Children with Disabilities.

Training will be provided by an appropriately qualified person.

8. Implementation This policy will be disseminated through team briefings and be readily available on AfC’s intranet. Staff to whom this is relevant, will be advised of this policy by their line manager at their induction.

9. Audit and review The Clinical Governance Group will be responsible for ensuring that compliance to standards identified in this policy is achieved. Audits will be undertaken throughout AfC’s clinical areas.

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Audits will be used to inform attainment of the requirements as identified in the CQC fundamental standards and the best practice standards.

Any outcomes and recommendations of audit will be reported to the Clinical Governance Group.

10. Procedures and guidance All respiratory or cardiac arrests should be reported as a clinical incident and be processed and monitored in the same way as all clinical incidents with significant trends escalated for analysis and organisational learning.

Electronic reporting systems will keep a log of all incidents reported together with outcomes from local investigations.

10.1 In the event of an emergency, staff should carry out the following actions: establish the person’s resuscitation status - if there is a DNACPR/ADRT notice in place, please

refer to the DNACPR/ADRT Policy.

initiate BLS should not be delayed where a person’s DNACPR/ADRT status is unclear or unknown.

10.2 Do not attempt resuscitation (DNACPR/ADRT) and refusal to advance decisions to refuse (ADRT) treatment guidelines for children and young people under AfC

AfC has developed a DNACPR/ADRT policy that fully complies with the guidance decisions relating to cardiopulmonary resuscitation issued by the BMA, RCN, Resuscitation Council (UK) (Oct 2014).

Responsibility for the DNACPR/ADRT order lies with the senior healthcare professional in charge and must be communicated to all relevant healthcare professionals, the family and carers.

It is also their responsibility to enter the DNACPR/ADRT decision in the patient’s healthcare records, including the rationale for the decision and those who have been involved in the discussions. The decision should be reviewed on transfer, admission into and across services and thereafter regularly reviewed in light of the patient’s condition. It should also be documented in the healthcare records.

Where appropriate, the information should be available to the London Ambulance Service and for children and young people known to the Specialist Palliative Care Service, similar information should be held on the palliative care registers held by GPs.

For advice and information on DNACPR/ADRT or any other issue contact the appropriate senior clinician for further advice.

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10.3 Initiation of the resuscitation and summoning of help The guidance in this policy follows recommendations by the Resuscitation Council (2015).

All respiratory or cardiac arrests should result in emergency services being called as soon as possible.

In the child’s or young person’s home, the clinician may call a family member or carer and ask them to summon help by dialling 999 or 112 from mobiles or do so themselves.

All staff should ensure that they implement resuscitation in line with the training they have received (please see Appendices 1-5 for algorithms).

Where the child or young person is wearing a back brace this needs to be removed in order to initiate BLS.

Where there is no time to establish the medical history and/or in the absence of a prior decision not to resuscitate, BLS must be initiated. This is in accordance with both professional responsibilities and legal obligations.

Failure to attempt BLS based on an assessment of the patient’s condition by a practitioner not in possession of the appropriate information, may attract legal action against the practitioner and/or AfC.

All staff members that may be involved in resuscitation decisions have a responsibility to understand and implement this policy. The policy is accessible on the AfC Intranet.

10.4 Paediatric resuscitationAfC staff working with children often work alone. Although they may have to resuscitate a child (or an adult), this would not be a part of their normal role, and would be a very unusual event.

All staff routinely working with children should ensure that they undertake annual BLS training in line with AfC policy which includes paediatric BLS (Appendix 3) and choking (Appendix 4).

10.5 Non-Achieving for Children premisesWhere care is being provided by AfC employed staff on non-AfC premises the BLS/CPR procedures for that setting should be followed.

Where AfC does not provide the service, it is the responsibility of the provider organisation to ensure that appropriate measures are taken for a safe and effective response to respiratory or cardiac arrest.

In situations where services are provided alongside external services within the same site, services leads or managers should ensure that local arrangements are in place for children, young people, families and carers accessing the site to have access to BLS in the event of an emergency.

10.6 Out of hoursAll staff must follow the specific guidance for the area they are working in. In the absence of a DNACPR/ADRT order, all staff are required to call 999 or 112 from mobile phones in the event of an emergency which requires assistance with CPR both in and out of hours.

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11. Resuscitation careThe organisation must make provisions for safe continuity of care and where necessary, safe transfer following resuscitation of the patient. This may involve the following steps:

informing relatives or carers initially and of outcomes

referral to local acute services

full and complete handover of care

liaison with the ambulance services.

11.1 Anaphylaxis for adults and paediatrics AfC provides care for children and young people where there is a potential risk for an anaphylactic reaction such as administration of medication and outings involving mealtimes with possible cross contamination of foods.

AfC staff who provide care for children and young people need to be aware of anyone under their care who is known to suffer with anaphylaxis. They need to be aware of triggers, symptoms and treatment. Annual training should be received to update skills.

Should someone present with symptoms of anaphylaxis and they do not have emergency treatment prescribed for them, then emergency services must be called immediately on 999.

The management of suspected anaphylactic reactions should be conducted in accordance with training with the Resuscitation Council (UK) Guidelines (2015) for the management of anaphylaxis. Please see Appendix 5.

11.2 Airway managementExpired air ventilation is the minimum standard expected and should be performed with a face shield or pocket mask incorporating a one way valve to prevent secretions from the patient reaching the rescuer. Other simple airway barrier devices do not permit ventilation to be performed as effectively as the pocket mask and many provide significant resistance to lung inflation.

Chest compressions combined with effective ventilation remain the standard, but in circumstances where staff are justifiably unwilling or unable to perform effective rescue breaths, compression only BLS is acceptable and would be preferable to doing nothing at all.

Please be aware: Devices such as the oro-pharyngeal airway (Guedel airway) and I Gel Supraglottic airway are suitable for use by those who are appropriately trained and a range of sizes may need to be kept available.

For resuscitation guidelines for babies and children with tracheostomies, refer to Appendix 6.

11.3 Defibrillators: automated external defibrillator (AED)AEDs are currently available. Service leads must ensure that staff are trained in their use and that the AED is serviced and maintained in line with manufacturer’s instructions. Weekly checks of the AED are required to ensure that they are working. This information must be recorded on an equipment check list weekly.

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11.4 OxygenCurrent resuscitation guidelines emphasise the use of oxygen. In the community setting availability may be very limited, and will not necessarily be readily available. Where oxygen is issued, oxygen cylinders should be appropriately maintained and national safety standards followed.

11.5 DrugsFew drugs have been shown to materially influence the outcome of cardiopulmonary arrest and few are recommended for routine use.

12.0 Standards in clinical areas The following must be in place in all AfC sites where services for children and young people are provided.

All services must undertake a risk assessment of their service areas to determine where additional equipment is required.

Basic equipment required for BLS should be available in all health care settings where staff carry out clinical procedures.

All services must ensure that staff know where to find equipment when it is needed and training in its use must be undertaken to a level appropriate to the individual’s expected role.

There must be a nominated person(s) responsible for checking and recording the state of readiness of the equipment a minimum of once a week. However, all staff have a responsibility to familiarise themselves with the emergency equipment within their clinical environment.

Staff carrying out clinical procedures away from a healthcare setting, such as a in a child or young person’s, home do not normally need to carry resuscitation equipment, although they should carry an airway adjunct such as a pocket mask or face shield as a precaution against infection.

Where specific equipment is required for higher risk procedures such as a tracheotomy tube change, it is expected that staff will not carry out a procedure without the appropriate equipment available.

12.1 Ensuring resuscitation equipment is maintainedResuscitation equipment will be used relatively infrequently, it must therefore be both easy to use and maintain.

12.2 Document equipment checksWhere appropriate, documented equipment checks should include the following:

tested and electrical safety stickers are within date

suction equipment performs to its specification. If battery powered, check charging light is on and functional check when disconnected from charger.

ensure oxygen cylinder contains sufficient gas. Check oxygen is present at flow meter outlet when turned on with a maximum delivery of up to15l/m. Check for leaks.

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12.3 Cross infectionWhilst the risk of infection transmission from patient to rescuer during direct mouth-to-mouth resuscitation is extremely rare, isolated cases have been reported. It is therefore advisable that direct mouth-to-mouth resuscitation be avoided in the following circumstances.

All children and young people who are known to have or suspected of having an infectious disease.

All undiagnosed children and young people entering a clinical area or in their own home.

Other people where the medical history is unknown.

All clinical areas should have immediate access to airway devices (such as a pocket mask) to minimise the need for direct mouth-to-mouth ventilation. However, in situations where airway protective devices are not immediately available, start compression only Basic Life Support whilst awaiting an airway device. If there are no contraindications consider giving mouth-to-mouth ventilations.

12.4 Manual handlingIn situations where the collapsed person is on the floor, in a chair or in a restricted or confined space, the organisational guidelines for the movement of the individual must be followed to minimise the risks of manual handling and related injuries to both staff and the person. In the event that the person who needs resuscitation is in a wheelchair, lower to the ground as quickly but safely as possible, always supporting the head.

Please also refer to AfC’s Moving & Handling Policy on the intranet and the Resuscitation Council (UK) guidance, which can be found at: www.resus.org.uk/publications/guidance-for-safer-handling-during-BLS/CPR-in-healthcare-settings

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13. ReferencePocket Guide to Teaching for Medical Instructors, Third Edition (2015).Ian Bullock, Mike Davis, Andrew Lockey and Kevin Mackway-Jones), BMJ Books.

Mental Capacity Act 2005 Department of Healthwww.dh.gov.uk/en/SocialCare/Deliveringadultsocialcare/MentalCapacity/MentalCapacityAct2005/index

NHSLA Risk Management Standards 2013/14www.nhsla.com/Safety/Documents/NHS%20LA%20Risk%20Management%20Standards%202013-14.pdf

Resuscitation Policy, Health Services Circular (HSC) 2000/028. Department of Health.Guidance from the British Medical Association, the Resuscitation Council (UK), and the Royal College of Nursing (previously known as the ‘Joint Statement’) www.resus.org.uk/dnacpr/decisions-relating-to-cpr

Cardiopulmonary Resuscitation, Standards for Clinical Practice and Training. Resuscitation Council (UK) (2004 updated 2008)A joint statement from the Royal College of Anaesthetists, the Royal College of Physicians of London, the Intensive Care Society and the Resuscitation Council (UK). www.resus.org.uk/pages/standard.htm

Resuscitation Guidelines 2015, Resuscitation Council (UK) (2015) www.resus.org.uk

Guidance for Safer Handling during Resuscitation in Healthcare setting Resuscitation Council (UK), July 2015www.resus.org.uk/publications/guidance-for-safer-handling-during-cpr-in-healthcare-settings

The National Council for Palliative Care www.ncpc.org.uk

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Appendix 1 – Adult basic life support

Adult basic life support algorithm Resuscitation Council 2015

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Appendix 2 – Adult choking treatment

Resuscitation Council 2015

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Appendix 3 - Paediatric basic life support

Basic Paediatric Life Support Algorhythm Resuscitation Council 2015

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Appendix 4 – Paediatric choking treatment

Resuscitation Council 2015

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Appendix 5: Anaphylaxis

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Appendix 6: Basic life support for babies and children with a tracheostomy

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Appendix 7: Compression only Basic Life Support

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Membership of policy development groupTeresa Candfield Associate Director Health Partnerships

AfC Consultation Group

Heather Anderson Health and Therapies Manager (Deputy Head of ISCD)

Caroline Baxter Head of Integrated Service for Children with a Disability

Caroline Jager Short Breaks and Aiming High Manager

Geraldine Burgess Home and Community Support Manager

Mary Head Deputy Head of Service, Emotional Health Service (EHS)

Robert Henderson Deputy Chief Executive

Simon James Associate Director SEND

Sandhya Kenyon Community Paediatrician KHFT

Divya Pore Community Paediatrician KHFT

Alison Pearce Community Paediatrician KHFT

Lynn Lock Young People Substance Misuse Service Manager

Heidi Mansfield Crofters Manager/Interim Croft Cottage Manager

Catherine Johnson Lead Occupational Therapist (ISCD)

Candice Raymond Lead Physiotherapist (ISCD)

Nicola Rocca Team Leader, Disabled Children's Nursing Team

Jo Steer Head of Service Emotional Health Service (EHS)

Anne Greenhill School Nurse, Bedelsford School

Kate Barron School Nurse, Bedelsford School

Liz Holmden School Nurse, Bedelsford School

Samantha Daniels School Nurse, Dysart School

Jodie Cullen School Nurse, Dysart School

Jane Park Community Nurse

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