Resuscitation and the deteriorating adult procedure

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

Definitions
Term	Definition
Cardiorespiratory arrest	Cardiorespiratory arrest is defined clinically by unconsciousness in association with no established breathing pattern and no signs of life
Cardiopulmonary resuscitation	CPR is a combination of external chest compressions, artificial respiration, and defibrillation. It is undertaken to restore breathing and circulation in a person where these life-giving functions have failed
Choking	Choking is the occlusion of the airway by a foreign body, causing the inability to breathe, it is a medical emergency and can, if not treated cause cardiorespiratory arrest
Anaphylaxis	Anaphylaxis is a severe, life threatening, generalised, or systemic hypersensitivity reaction
Community life support	Community life support is resuscitation training that includes the recognition of cardio- respiratory arrest, how to provide external chest compressions and artificial respiration, how to deal with choking situation in adults and children, the manual handling of a patient in emergency situations and the introduction to defibrillation
Immediate life support	Immediate life support is training that includes the recognition of the deteriorating patient and cardiorespiratory arrest, how to provide external chest compressions, artificial respiration, and defibrillation, and how to deal with a choking situation in adults and children. The course also includes the use of the early warning score, neurological observations, oxygen therapy, suction, the dangers of restraint and rapid tranquillisation

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
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

4.5 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:

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

Document control

Version: 1.4.
Date ratified: 1 August 2023.
Ratified by: Clinical policies review and approval group.
Name of originator: Resuscitation officer.
Name of responsible individual: Executive director of nursing and allied health professionals.
Date issued: 16 August 2023 amendment.
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: Amendment to head injury 2.4 and appendix 2.5.

Page last reviewed: April 24, 2024
Next review due: April 24, 2025

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