Resuscitation and the deteriorating adult procedure

Contents

1 Aim

The availability of suitable cardio-pulmonary resuscitation is expected of healthcare services, and a service user has the right to expect such support from a healthcare provider. Therefore, it is recognised that employees of Rotherham Doncaster and South Humber NHS Foundation Trust (hereafter known as the trust) may be involved in resuscitation procedures in the course of their work.

As a provider of specialist mental health, learning disability and community services it is essential that the trust provides resuscitation at an appropriate level. For effective life support, standardised equipment, training, and protocols must be provided. Across the trust this provision will be determined by the location of the healthcare facility, the staff available and the type of healthcare provided and will at all times be supported by the local ambulance service.

This procedure outlines the systems in place in the trust to provide high quality resuscitation to its patients at all times.

1.1 Definitions

2 Scope

This procedure applies to all managers with responsibilities derived from it, and all clinical staff with direct patient contact, including bank, agency, and temporary staff who may come into contact with a patient, visitor or member of staff in cardiorespiratory arrest.

3 Link to overarching policy

The procedure should be read in conjunction with the associated documents within the resuscitation manual.

Resuscitation manual (includes the deteriorating patient, DNACPR adult, DNACPR child and ReSPECT).

4 Procedure

4.1 Cardiopulmonary arrest prevention and the deteriorating patient

The resuscitation service will work alongside the trust clinical quality lead (physical health and wellbeing) to promote the importance of physical wellness and healthy lifestyles.

The trust will wherever possible promote the prevention of cardiopulmonary arrest occurring by monitoring and observing:

• physically unwell and deteriorating patients
• those being restrained both during and after the restraint
• those that have been given rapid tranquillisation
• those with Head injuries or possibility of head injury (unwitnessed fall)
• those who have been suspected of using a ligature

Physical observations for these patients will be taken in conjunction with the use of a track and trigger system the National early warning score 2 (NEWS2), a plan for vital signs monitoring that identifies which variables need to be monitored including the frequency of measurements, as advised by the Resuscitation Council, National Institute for Health and Care Excellence (NICE) and National Confidential Enquiry into Patient Outcome and Death (NCEPOD).

To work alongside the NEWS2 and Neuro observations the resuscitation service has developed flow charts for both head injuries and ligatures.

4.2 Emergency life saving drugs

The provision of standardised medication to treat the deteriorating patient is vital, therefore, all inpatient areas carry drugs that can be given in emergency situations by a registered nurse, these drugs will be kept in stock medication cupboards, easily accessible at all times, stored with the appropriate paraphernalia to administer, and the appropriate flow chart displayed on the within the cupboard.

These drugs are:

• aspirin
• glyceryl trinitrate (GTN) spray
• naloxone
• glucagon or glucogel
• adrenaline
• oxygen

When an emergency lifesaving drug is administered the following details must be recorded in the patient records: date, time, drug name, strength, dose, route, batch number and expiry date along with the details of the patient’s presentation at the time of administration.

See appendix C for flow charts for administration.

4.3 Equipment

The provision of suitable, standardised equipment is paramount in resuscitation so that staff are familiar, proficient and confident with the use of that equipment.

For areas revaluating the provision of resuscitation equipment within their areas the trust emergency equipment risk assessment must be used in conjunction with discussions with the resuscitation officer.

Details are shown in appendix D, equipment required in healthcare areas.

4.4 Initiation of and criteria for resuscitation

All patients, visitors, and staff who collapse within the vicinity of trust premises are to be resuscitated in line with this procedure. All patients being attended by a clinician, whether in hospital, healthcare unit or their own home, are to be actively and vigorously resuscitated, and suitable assistance called, unless they have a do not attempt cardio-pulmonary resuscitation (DNACPR) order in place, rigour mortis is present, or there are signs of decomposition. The temperature and pallor of the person’s skin should not be used as an indicator of the initiation of CPR.

In circumstances where staff think the casualty should have a DNACPR order, but doesn’t, full resuscitation is to be attempted until an ambulance arrives and takes over, or a recognised doctor issues orders to stop resuscitation efforts.

On finding someone collapsed, staff should immediately assess the casualty, using the danger, response, airway, breathing and circulation (DRABC) approach, and summon further assistance by initially shouting for help and activating any alarm systems in place. As soon as a medical emergency has been identified, then an ambulance will be summoned by:

• all areas within Tickhill Road Hospital and Tickhill Road Site

Dialling: 2222 on the internal phone system, state cardiac arrest, the caller will be given instructions by switchboard staff to enable the call to be transferred to the ambulance service.

• Great Oaks dialling: 9-999
• Woodlands dialling: 9-999
• Swallownest Court dialling: 9-999
• All other areas dialling: 999
• Softphone: 999 goes straight through to emergency services

4.4.1 Relatives who choose to witness resuscitation attempts

The Resuscitation Council UK (RCUK) suggested that family members who witness the resuscitation process may have a healthier bereavement, as they will find it easier to come to terms with the reality of their relative’s death and may feel reassured that everything possible has been done. It is acknowledged that the reality of CPR may be distressing, but in the latest edition of RCUK’s advanced life support manual, the RCUK argues that “many relatives want the opportunity to be present during the attempted resuscitation of their loved one” (RCUK, 2021).

Each cardiac arrest situation needs to be taken on a case-by-case basis and if there is opportunity and time to invite family members and loved ones to witness the resuscitation process then this should be accommodated. However, as we know there are some situations this may be difficult, and therefore the appropriate support should be offered such as effective communication from one professional from the care team to speak with the family, provision of a suitable room to speak to family, breaking bad news and supporting the grief response, arranging viewing of the body and religious requirements, legal and practical arrangements as stated from the RCUK paper wherever possible.

In the community setting, where staff often visit patients alone, the trust support staff prioritising the clinical emergency first and if there is an opportunity after the event then to support the family.

4.5 DNACPR orders

In line with the HSC 2000/028, the trust has adopted the Yorkshire and Humber region system whereby a patient or medical officer can withdraw the provision of resuscitation. The trust DNACPR procedure can be found in the do not attempt cardiopulmonary resuscitation within the resuscitation manual. It is the responsibility of all staff to know which process is to be followed for DNACPR in their care group for example, the ReSPECT process or V13 DNACPR.

4.6 Incident reporting, including external reporting requirements

All resuscitation attempts should be reported on the trust safeguard incident reporting system (IR1) and by the completion of the cardiac arrest report form (appendix E) which must be received by the resuscitation Officer within 24 hours of the incident.

All serious (life threatening) sudden medical emergencies, for example, choking and anaphylaxis, and any emergency medical equipment failures should be reported using the trust safeguard incident reporting system (IR1). Patient safety incidents are required to be reported to the National Patient Safety Agency (NPSA), deaths to the coroner’s office and certain deaths to the care quality commission. Please see the incident management policy for details.

5 Links to associated documents

This procedure should be read and implemented in association with the following trust policies:

• Consent to care and treatment policy
• Clinical risk assessment and management policy
• Clinical skills policy
• Incident management policy
• Infection, prevention and control manual
• Mandatory and statutory training policy
• Mental capacity policy
• Medical devices management policy
• Slips, trips and falls for staff and visitors, prevention and management policy
• Rapid tranquillisation policy and guidelines

6 References

• Resuscitation Council (UK) (2021) resuscitation guidelines (opens in new window).

7 Appendices

Please see resuscitation manual webpage for appendices attached to this procedure.

• Appendix A Resuscitation committee terms of reference
• Appendix B The deteriorating patient HA
• Appendix B1 New head injury flow chart
• Appendix B2 Ligature flow chart
• Appendix B3 Normal parameter exception care plan
• Appendix C Emergency drugs
• Appendix D Emergency equipment
• Appendix D1 Equipment checklist
• Appendix D2 Grab bag checklist
• Appendix E Cardiac arrest report form

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Document control

• Version: 1.5.
• Date approved: 6 August 2024.
• Ratified by: Clinical policies review and approval group.
• Name of originator: Resuscitation officer.
• Name of responsible individual: Chief Nurse.
• Date issued: 28 August 2024.
• Review date: June 2025.
• Target audience: All clinical staff working in all service areas including the community. All staff working in areas where patients are present including bank, agency, and temporary staff.
• Description of change: In section 4.4 new paragraphs covering relatives who choose to witness resuscitation attempts. This is a mandatory requirement to meet the standards of the Resuscitation Council UK.

Page last reviewed: December 12, 2024
Next review due: December 12, 2025

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