POLICY REFERENCE NUMBER SABP/RISK/0029

POLICY NAME Managing Medical Emergencies (including Resuscitation and Anaphylaxis) Policy

BRIEF OUTLINE OF THIS POLICY This policy outlines the procedures necessary to ensure that all staff are competent to a level which will provide appropriate care for people who use our services in the event of a medical emergency or cardiac arrest prior to the arrival of the ambulance. The policy adheres to the Resuscitation Council (UK) Guidelines 2015, national Patient Safety Agency Rapid Response Report (26NOVNPSA/2008/RRR010), the NICE Guidelines 25 and Trust Clinical Procedures.

Version Number 7.0 Approving Committee Executive Board Policy Category Clinical Executive Lead Chief Nursing Officer Name of Author Resuscitation and Medical Emergencies Officer

Date Approved 8th December 2018 Date Issued 18th February 2021 Review Date 8th June 2022 Target Audience All directorates, clinical and managerial staff

KEY PRINCIPLES ABOUT THIS POLICY 1. Management of Medical Emergencies 2. Resuscitation 3. Procedural Responsibility

This policy has been reviewed and is compliant with the most up to date Code of Practice and NICE Guidelines Title of Code of Practice NICE Reference Number(s) Resuscitation Council (UK) Guidelines 2015, NICE Guidelines 25 National Patient Safety Agency Rapid Response Report (26 NovNPSA/2008/RRR010)

VERSION CONTROL LIST

Version Date Author Status Comment

1 Nov 09 Simon Whitfield and live Mayvis Oddoye 1.1 May 11 Simon Whitfield and draft Substantial review Mayvis Oddoye 1.2 July 11 Simon Whitfield and draft Comments Mayvis Oddoye received from Fiona Lockwood 1.3 July 11 Simon Whitfield draft andVersion Julie Smith sent out for consultation 1.4 September 11 Simon Whitfield draft Ready to go to Oct 11 PAG 1.5 May 12 Amanda Shaw draft Approved at PAG

2 June 12 live Approved by Exec board 2.1 July 14 Simon Whitfield and draft Mayvis Oddoye 2.2 October 14 Simon Whitfield and draft Mayvis Oddoye 2.3 March 15 draft

2.3 August 15 draft Presented to PAG. Further amendments required 2.4 Nov 15 draft Approved at PAG

3 Nov 15 live

3.1 Feb 16 draft One minor amendment 4 Feb 16 Live

4.1 June 16 draft Amendment to emergency drugs 4.2 Oct 16 draft Returnedprotocol to PAG for final approval 5.0 April 2017 Live Approved by PAG 5.1 October 2018 Paul Luker draft Substantial review

6.0 January 2019 Paul Luker Approved

7.0 February 2021 Paul Luker Approved Covid Review extension agreed

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Summary of Changes since Version 4.2

Numbers (Select the appropriate action) Original/New/Amendment/Deleted – Statement Page Paragraph Appendix (select the appropriate action) All Logo changed to reflect current branding

All Multiple wording changes to update whole policy

7 The contact number 112 is an alternative number to 999 and directs calls to the same emergency call centre as the 999 number but can be used from mobiles

9.4.9 Addition of ‘carers’ to text

2.3 Addition of text: Staff employed in a clinical or care role by the Trust must comply with the requirements laid out in this procedure.

10 Addition of ‘Water for Injection’ to checking table

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Contents Page Section Page POLICY SECTION Version Control List 2

Summary of Changes 3 1.0 Policy Purpose 5 2.0 Policy Statement 5

3.0 Related Policies 6

4.0 Glossary of Terms 6

5.0 References 7 PROCEDURE SECTION 6.0 Roles and Responsibilities 8

7.0 Procedure Flow Chart 10

8.0 Procedure Statement 13

9.0 Procedure / Process 13 9.1 Categorisation of Risk Areas 13 9.2 the Modified Early Warning System (MEWS) 13 9.3 Managing Medical Emergencies Including Resuscitation and 14 Anaphylaxis 9.4 Post Incident 16 9.5 Training Requirements 18 9.6 Equipment 21 9.7 Approved Emergency Medicines 23 9.8 Ordering, Location, Checking and Maintaining Medical 25 Emergency / Resus Equipment and Medication 9.9 Infection Control 26 9.10 Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) 26 9.11 Post Incident Debriefing 30 9.12 Cardiac Arrest Audit and Monitoring 30 9.13 Unannounced Medical Emergency / Cardiac Arrest Drills 31 10.0 Monitoring Table 32

11.0 Equality Analysis 33

12.0 Appendices 37

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POLICY SECTION 1.0 Purpose 1.1 The purpose of this policy is to ensure the Trust delivers an effective and timely response to medical emergencies, including cardiac arrest, which is compliant with the latest legislation, guidance and recommendations.

2.0 Policy Statement 2.1 The Trust’s policy will adhere to the Resuscitation Council (UK) Guidelines 2015, National Patient Safety Agency Rapid Response Report (26 NovNPSA/2008/RRR010) and the NICE Guidelines 25 and Trust Clinical Procedures in order to ensure that all staff are competent to a level which will provide appropriate care for people who use our services in the event of a medical emergency or cardiac arrest prior to the arrival of the ambulance. • NICE guidelines state that staff involved in administering or prescribing rapid tranquillisation, or monitoring service users, to whom parenteral rapid tranquillisation has been administered, should receive ongoing competency training to a minimum of immediate life support (ILS–Resuscitation Council UK) and the use of defibrillators. • Staff who employ physical intervention or seclusion should as a minimum be trained in basic life support (BLS – Resuscitation Council UK).

2.2 This policy also takes into account the Human Rights Act of 1998 in decision making particularly relevant to decision about attempted CPR in the context of the following points: • The right to Life (article 2) • The right to be free from inhuman or degrading treatment (article 3) • The right to respect for privacy and family life (article 8) • The right to freedom and expression, which includes the right to hold • opinions and to receive information (article 10) • The right to be free from discriminatory practices in respect of these rights (Article 14)

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2.3 Staff employed by the Trust must comply with the requirements laid out in the Managing Medical Emergencies including Resuscitation and Anaphylaxis Procedure which cover: • Roles and Responsibilities of staff • Equipment • Training • Monitoring • Documentation • Drills

2.4 This policy and procedure will specifically cover Resuscitation and Anaphylaxis. However it is expected that staff will respond quickly to all medical emergencies and alert the appropriate emergency service(s)

3.0 Related SABP Policies Learning and Development Policy, Medicines Policy

4.0 Glossary of Terms Basic Life Support (BLS) BLS implies that no equipment is required to give cardio-respiratory resuscitation, other than a protective device to allow the responder to give ventilations without risk of infection transmission.

Automated External Defibrillators (AEDs) Automated External Defibrillator (AED) - The machine analyses the heart rhythm and will automatically deliver a defibrillation shock via the defibrillation electrodes only if an arrhythmia with a shockable rhythm is present. This machine will not allow a shock to be delivered inappropriately. This defibrillator must not be used on neonates or infants.

Immediate Life Support (ILS) NICE Guideline 25 requires that where rapid tranquillisation, physical intervention or seclusion are used, there should be access within 3 minutes to appropriately trained

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personnel and equipment including an AED, bag valve mask, oxygen, cannulas, fluids and suction .

5.0 References • Resuscitation Council (UK) Guidelines 2015 • National Patient Safety Agency Rapid Response Report (26NovNPSA?2008/RRR010) • Nice Guidelines 25 • Trust Clinical Procedures • Human Rights Act 1998 • Guidance from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing 2016 (previously known as the HSC2000/028 ‘Joint Statement’) • Mental Health Capacity Act 2005 • British Medical Association, 2007, “Advance decisions and proxy decision- making in medical treatment and research”

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PROCEDURE SECTION

6.0 Roles and Responsibilities 6.1 Staff employed in a clinical or care role by the Trust must comply with the requirements laid out in this procedure.

6.2 All staff employed by the Trust need to be familiar with their roles and responsibilities as outlined by this procedure.

6.3 The roles and responsibilities of staff depend on the categorisation of risk for their area of work and their individual role within that area.

6.4 Health professionals need to be aware of the law in relation to decision- making for different groups:

• Competent adults (see appendix 1 for further information) • Incompetent adults (see appendix 2 for further information) • Children and young people (see appendix 3 for further information)

6.5 It is the responsibility of all staff to ensure they undertake the correct training to support the implementation of this procedure.

6.6 It is the responsibility of all ward/unit managers in conjunction with the Matron/Service Manager to ensure that appropriate life support equipment is in place at all times, properly maintained (Including mandatory checks), easily accessible and that all staff are competent to administer an appropriate level of life support.

6.7 The Consultant Nurse for Safeguarding Children is the Trust Lead for Resuscitation.

6.8 The Director of Risk and Safety is the Trust Lead Director for Medical Emergencies and Resuscitation.

6.9 The Education Department in conjunction with the Trust Resuscitation and Medical Emergencies Officer (RMEO) will be responsible for ensuring a rolling program of training and development to ensure a level of competence in staff that will adequately support this procedure.

6.10 The Resuscitation Steering Group will review the effectiveness of the current arrangements and will review changes in practice and support the Page 8 of 55

implementation of any policy changes or best practice recommendations which need to be made

6.11 The Trust Quality Committee will monitor the effectiveness of the arrangements for dealing with Medical Emergencies and Resuscitation on an annual basis.

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7.0 Procedure Flow Chart 7.1 Decisions Relating To Cardiopulmonary Resuscitation Issues for Consideration: Competent Adults

Information giving • Ensure patient has access to information about decision making in relation to CSR

Discussion • Senior health professional should initiate sensitive discussion with patient • Respect patient’s wishes not to

Assess the clinical issues • Is CPR likely to restart the patient’s heart and breathing?

• Would restarting the patient’s heart and breathing provide any benefit? • Do the expected benefits outweigh the potential burdens of the treatment?

Seek consensus • Responsibility for the decision rests with the Consultant

Communicate the decision • Ensure effective communication of decision to relevant health professionals

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7.2 Decisions Relating to Cardiopulmonary Resuscitation Issues for consideration: Adults who lack capacity

Is there a valid and applicable advance refusal of CPR? NO YES

Mental Capacity Act 2005 (England & Wales)

Consult an appointed Welfare Attorney, or in the Communicate the decision absence of a Welfare Attorney consult family / appropriately and promptly. friends of patient or appointed Independent Ensure it is in the SU’s Mental Capacity Advocate in accordance with the notes and staff are aware. Mental Capacity Act 2005

Assess the best interest of the patient: What is known about the patient’s wishes regarding resuscitation? Did the patient request confidentiality? Did the patient identify people to be consulted about treatment? See the views of people close to the patient Record SU’s wishes clearly about what he or she would want? in notes and communicate Discuss with the clinical team decision to relevant health professionals in case of transfer to other Assess the clinical issues: Services/Trust Areas. Is CPR likely to restart the patient’s heart and breathing? Would restarting the patient’s heart and breathing provide any benefit? Do the expected benefits outweigh the potential burdens of treatment?

Seek consensus: Responsibility for the decision rests with the consultant in charge of the care

Communicate the decision: Ensure effective communication of decision to relevant health professionals

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7.3 Decisions Relating to Cardiopulmonary Resuscitation Issues for consideration: Children and young people

Assess the best interests of Decision-•making the patient • Parents are the usual proxy • Is the child able and willing decision-makers for children to discuss resuscitation? who are unable or unwilling to • What are the child’s views decide for themselves about resuscitation? • Competent young people • What are the parent’s must be offered the views about resuscitation? opportunity to participate in • Discuss with clinical team. decision-making

• Competent young people may give consent to medical Assess the clinical issues treatment • Is CPR likely to restart the • In England, Wales and child’s heart and breathing? Northern Ireland consent from a person with parental • Would restarting the responsibility or a court may child’s heart and breathing override a competent young provide any benefit? person’s refusal of treatment

• Do the expected benefits • In Scotland, it is likely that outweigh the potential neither parents nor the court burdens of treatment? may override a competent young person’s refusal of treatment

See consensus • Where there is serious disagreement between the

Responsibility for the family andCommunicate health team, legalthe decision decision rests with the advice should be sought. consultant in charge of the • Health professional in charge to patient care ensure effective communication of decision to other relevant Communicate healththe decision professionals .

• Health professional in charge to ensure effective communication of decision to

other relevant health professionals.

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8.0 Procedure Statement The purpose of this procedure is to ensure the Trust delivers an effective and timely response to medical emergencies, including cardiac arrest, which is compliant with the latest legislation, guidance and recommendations.

Staff employed in a clinical or care role by the Trust MUST comply with the requirements laid out in this procedure.

9.0 Procedure/Process 9.1 Categorisation of Risk Areas For the purposes of this policy the service areas of the Trust have been divided into two categories according to the level of risk associated with the clinical interventions delivered.

Category A sites • All acute care inpatient services • Social Care homes with nursing • All departments where there are specialist treatments being undertaken such as ECT, Rapid Tranquilisation, physical interventions or seclusion and drug and alcohol community teams.

Category B sites • All community based services, respite and social care homes not in category A

9.2 The Modified Early Warning System (MEWS) - Due to the high mortality rate following cardiopulmonary arrest, it is important to recognise those people most at risk.

If they can be identified before cardiac arrest and the cardiac arrest prevented, lives will be saved. This can be achieved by using the Modified Early Warning System (MEWS). See Appendix 1.

By taking a medical history and performing physical observations supported by investigations when indicated, monitoring individuals on high risk treatments e.g. Page 13 of 55

high dose antipsychotics, and ensuring early access to defibrillation and Basic/Immediate Life Support the chance of survival is optimised.

9.3 Managing Medical Emergencies including Resuscitation and Anaphylaxis 9.3.1 Category A sites 9.3.1.1 If an individual has been prescribed an Auto-injector because they are at significant risk of an anaphylactic reaction e.g. to a bee sting, clinical staff who have been trained to use them in the Basic & Immediate Life Support Training must ensure they remain familiar with how to use the device in the event of an emergency. When administering a drug that has a significant risk of anaphylaxis e.g. vaccines, the anaphylaxis kit must be readily available and the individual observed for at least 20 minutes.

9.3.1.2 In the event of any medical emergency, including cardiac arrest, the 999 call for an ambulance must be made urgently and basic/immediate life support must commence until the emergency services arrive and take over the care of the person using our services.

9.3.1.3 Staff should not hesitate in activating the relevant emergency services if they have any concerns regarding the health and safety of any person under their care.

9.3.1.4 The most appropriate clinician at the scene (for example, someone who is ILS trained, if available) should coordinate the care provided until the emergency services arrive and take over the care of the person using our services. However, it is fully expected that all staff involved will contribute towards good practice and feel empowered to do so, reflecting the importance of human factors in critical situations. (see appendix 12)

9.3.1.5 Automated External Defibrillators must be used, where available, by staff irrespective of whether they have been trained in their use. ‘AEDs are safe and effective when used by laypeople, including if they have had minimal or no training. AEDs may make it possible to defibrillate many minutes before professional help arrives’ (Adult basic life support and automated external defibrillation Guidelines, Resuscitation Council UK Guidelines 2015)

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9.3.1.6 In the event of an emergency call being made staff must ensure that the ambulance and other medical personnel can gain access to the location of the incident where this is possible and safe to do so.

9.3.1.7 If staffing levels permit, deploy a member of staff at the access point to direct the emergency services to the incident.

9.3.1.8 Where appropriate, medical staff/ nursing staff who are trained and deemed competent in administering an approved emergency medicine must administer them. See the list of approved emergency medicines for Category A sites on the Medicines Summary Table at 9.7.3 below.

9.3.2 Category B sites

9.3.2.1 If an individual has been prescribed an Auto-injector because they are at significant risk of an anaphylactic reaction e.g. to a bee sting, clinical staff who have been trained to use them in the Basic & Immediate Life Support Training must ensure they remain familiar with how to use the device in the event of an emergency. When administering a drug that has a significant risk of anaphylaxis e.g. vaccines, the anaphylaxis kit must be readily available and the individual observed for at least 20 minutes.

9.3.2.2 In the event of any medical emergency, including cardiac arrest, the 999 call for an ambulance must be made and basic life support must commence until the emergency services arrive and take over the care of the person using our services.

Staff should not hesitate in activating the relevant emergency services if they have any concerns regarding the health and safety of any person under their care.

9.3.2.3 The most appropriate clinician at the scene (for example, someone who is ILS trained, if available) should coordinate the care provided until the emergency services arrive and take over the care of the person using our services. However, it is fully expected that all staff involved will contribute towards good practice and feel empowered to do so, reflecting the importance of human factors in critical situations. (see Appendix 8).

9.3.2.4 Automated External Defibrillators must be used, where available, by staff irrespective of whether they have been trained in their use. ‘AEDs are safe and

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effective when used by laypeople, including if they have had minimal or no training. AEDs may make it possible to defibrillate many minutes before professional help arrives’ (Adult basic life support and automated external defibrillation Guidelines, Resuscitation Council UK Guidelines 2015)

9.3.2.5 In the event of an emergency call being made staff must ensure that the ambulance and other medical personnel can gain access to the location of the incident where this is possible and safe to do so.

9.3.2.6 If staffing levels permit deploy a member of staff at the access point to direct the emergency services to the incident.

9.3.2.7 Where appropriate, medical staff/ nursing staff who are trained and deemed competent in administering an approved emergency medicine must administer them. See the list of approved emergency medicines for Category B sites at 9.7.3 below.

9.4 Post Incident 9.4.1 It is the responsibility of the ward or unit manager (or designated deputy) of each clinical area to ensure the following as soon as possible: • The privacy and dignity of the collapsed person is maintained.

• That relevant documentation has been completed.

• That the Resuscitation and Medical Emergencies Officer (RMEO) – on 07825193026 and all other relevant people have been informed

• The safety of everyone both physically and psychologically including signposting to the Trust Serious Incident Support Team (SIST)

• The equipment has been checked, replenished and replaced as necessary. The ward/unit manager is accountable for ensuring any items used are replaced at the earliest opportunity; and should contact the Medical Emergency Equipment Compliance Coordinator on 07990794054 to arrange rapid changeover. Any delay in replacement must be escalated to the RMEO and/or the Trust Lead for Resuscitation

• A Trust Datix incident form has been completed.

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Note: Any equipment used in a resuscitation must be kept (even if disposable) for any subsequent investigation.

9.4.2 Immediately after resuscitation, most people are clinically unstable and likely to require admission to a coronary care or critical care unit; this will depend on factors such as previous health, severity of illness, and underlying diagnosis.

9.4.3 A competent person should remain with the person at all times, until advised by the emergency services (ambulance team and medical team) with regard to appropriate treatment.

9.4.4 Continuity of care during this period is vital. Senior staff should be involved in the transfer and appropriate staff escorts provided. This is the responsibility of the manager (or designated deputy).

9.4.5 A member of staff with knowledge of the person using our services must be allocated to accompany paramedical crew in the ambulance to the appropriate accident and emergency department if appropriate and where staffing numbers permit.

9.4.6 The service manager or on-call Trust manager must be informed as soon as possible that a member of staff is escorting via an emergency ambulance, or that staffing does not allow escorting, so support to staff can be enabled as required.

9.4.7 The escort nurse will remain with the person using our services until the staff in the receiving hospital have been given the full medical and nursing handover and indicates they are no longer required, or if they are relieved from this duty by a SABP manager.

9.4.8 The persons’ condition should be stabilised as far as possible before transfer, but this should not delay definitive treatment.

9.4.9 Relatives and carers should be informed about the transfer of a person using services, but should not expect to travel with the person using our services.

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9.4.10 The manager (or designated deputy) will assess the supportive measures required for all the individuals involved and should also seek advice or guidance from the RMEO about clinical debriefing that may assist in future investigations. Resuscitation incidents can be very stressful events and physical and psychological safety is paramount. Staff may need further supportive measures such as ongoing supervision and/or staff counselling services and referral.

Psychological safety can be aided by referral to SIST and/or defusion by manager (or senior member of staff on duty). It should take place on the day of the event with individuals present at the time (see Appendix 8).

9.5 Training Requirements The training requirements for different staff groups will be descrbed in the Trust Training Needs Analysis. The process for managing staff compliance with the training requirements is described in the Learning and Development Policy.

9.5.1 Category A sites 9.5.1.1 All qualified nurses and doctors working in Category A sites must undergo annual immediate life support training. This also includes junior doctors working on-call.

9.5.1.2 This training will be delivered as a 1 day annual session for all required staff, and must be re-attended within 12 months in order to maintain compliance.

9.5.1.3 All other care staff working in Category A sites must undergo annual basic life support training including the use of Automated External Defibrillators

The Basic Life Support training will include: • Recognising and managing a patient in cardiac arrest using a systematic approach. • Understand the importance of prompt action in cases of cardiac arrest. • Initiate and maintain effective adult basic life support in accordance with current Resuscitation Council (UK) guidelines 2015, prior to the arrival of an Ambulance • To operate an automated external defibrillator (AED) safely for effective Page 18 of 55

management of cardiac arrest. • Recognition and treatment of medical emergencies including choking, sepsis and anaphylaxis • Oxygen awareness and basics

The immediate life support training will include: • The recognition of the critically ill patient and deteriorating patient • SBAR Handover techniques • Non-technical resuscitation and team leadership skills • Knowledge and skills in the prevention of cardiac arrest • Knowledge and skills in how to manage a cardiac arrest prior to the arrival of the ambulance • Anaphylaxis management • Initial resuscitation and safe defibrillation • Airway management • Use of a pulse oximeter • Administration of oxygen • Reporting and recording requirements • Location and familiarisation with the content of the green bags

9.5.1.4 The Trust has Resuscitation and other training programmes that are accessible to staff via ESR. Training programmes, dates and venues are also published on the Trust’s intranet. All Staff have a personal responsibility to maintain their knowledge and skills and keep up to date with their training requirements. It is the ward/unit/team manager’s responsibility to ensure all staff attend the required training.

9.5.1.5 All training will be recorded on ESR. CPD Certificates of attendance, valid for one year from the date of training, can be requested from the Education Department by delegates who attend the whole course and participate in both its theoretical and practical components. Assistance with ESR, Training programmes and locating courses of interest may be sought by emailing the Education Department - [email protected]

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9.5.1.6 The operation of automated external defibrillators can be performed by anyone, however it is preferable that those who have received the appropriate mandatory annual training do so.

9.5.1.7 All training will be conducted in accordance with the current Resuscitation Council Guidelines (UK) 2015 (most recent) and local trust policy.

9.5.2 Cateogory B Sites 9.5.2.1 All care staff working in Category B sites must undergo annual basic life support training including the use of AEDs.

The Basic Life Support Training will include: • Recognising and managing a patient in cardiac arrest using a systematic approach. • Understand the importance of prompt action in cases of cardiac arrest. • Initiate and maintain effective adult basic life support in accordance with current Resuscitation Council (UK) guidelines 2015, prior to the arrival of an Ambulance • To operate an automated external defibrillator (AED) safely for effective management of cardiac arrest. • Recognition and treatment of medical emergencies including choking, sepsis and anaphylaxis • Oxygen awareness and basics

9.5.2.2 The Trust has Resuscitation and other training programmes that are accessible to staff via ESR. Training programmes, dates and venues are also published on the Trust’s intranet. All Staff have a personal responsibility to maintain their knowledge and skills and keep up to date with their training requirements. It is the ward/unit/team manager’s responsibility to ensure all staff attend the required training.

9.5.2.3 All training will be recorded on ESR. CPD Certificates of attendance, valid for one year from the date of training, can be requested from the Education Department by

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delegates who attend the whole course and participate in both its theoretical and practical components

9.5.2.4 All training will be conducted in accordance with the current Resuscitation Council Guidelines (UK) 2015 and local Trust policy.

9.6 Equipment 9.6.1 Category A Sites 9.6.1.1 The following equipment must be available in all Category A sites: • A Defibrillator, including attached rescue pack that contains:

o 1 x Set spare electrode pads, o 1x Pair shears, o 1 x Disposable razor, o Disposable gloves, o 1 x Pocket mask o Towelling/swabs

• A Pulse-oximeter

• Resuscitation board

• Green bag containing:

Shears, wire cutters, Rescue 1 x Set Ligature Cutters Cutter, Big Fish & Res-q-hook) Pocket mask for ventilations Comes with reservoir and Oxygen Non re-breathing Oxygen mask tubing Sizes: 2 (Green), 3 (Orange), Oropharyngeal airway set 4 (Red) ,2,3,4 Sizes: 6 (Generally females), Nasopharyngeal airway set 7 (Generally Males) Sizes: 3 (Yellow), 4 (Green), 5 Standard Supraglottic Airway device (i-gel)* (Orange). *Resus Pack also contains: Page 21 of 55

*to be superseded by i-gel Resus pack Sachet of lubricant, Airway support through natural replacement process strap & 12 FG suction tube Face masks for ventilations (BVM use Sizes: 2 (White), 3 (Yellow), 4 ONLY) (Green) CD size Oxygen (o2) cylinder With variable flow-rate Includes self-inflating reservoir, Disposable bag-valve-mask (BVM) set mask and tubing Case must contain: Yankauer suction catheter & suction tubing Laerdal Compact Suction Unit with (must be attached to suction unit in protective case readiness) and flexible suction catheters Lubricating Jelly For Naso/Oropharyngeal airways Magill forceps, scissors, surgical Misc. Items tape and stethoscope

9.6.2 Category B sites 9.6.2.1The following equipment must be available in all Category B sites: • A Defibrillator, including attached rescue pack that contains: o 1 x Set spare electrode pads, 1x Pair shears, 1 x Disposable razor, Disposable gloves, 1 x Pocket mask , Towelling/swabs

Social Care Homes • A Defibrillator, including attached rescue pack that contains: o 1 x Set spare electrode pads, 1x Pair shears, 1 x Disposable razor, Disposable gloves, 1 x Pocket mask , Towelling/swabs

• A CPR resuscitation backboard

Respite Homes • A Defibrillator, including attached rescue pack that contains: o 1 x Set spare electrode pads, 1x Pair shears, 1 x Disposable razor, Disposable gloves, 1 x Pocket mask , Towelling/swabs

• A CPR resuscitation backboard Page 22 of 55

9.7 Approved Emergency medicines 9.7.1 The following emergency medicines will be available in all Category A areas:

For Anaphylaxis Adrenaline 1 in 1000 (1mg/ml) for i/m use ONLY or auto injector (where agreed)

All Category A areas that are inpatient units which have access to junior doctors and the junior doctor on-call rota must hold the following medicines: • Actrapid Insulin vial + insulin syringes Aspirin 300mg tablet • Chlorphenamine 10mg/ml Diazepam rectal solution Flumazenil injection 100mcg/ml Glucagon injection 1mg/ml • Hydrocortisone sodium succinate 100mg inj. • Glucose oral gel • Glyceryl trinitrate aerosol spray 400mcg Naloxone injection 400mcg/ml Procyclidine injection 5mg/ml • Salbutamol inhaler 100mcg • Salbutamol nebules 5mg • Water for injection

Areas of special Consideration: Electroconvulsive Therapy (ECT) Suite: The ECT suite MUST hold a full cardiac arrest/deteriorating patient/reversible causes pharmacological interventions kit.

9.7.2 The following emergency medicines will be available in all Category B areas where vaccines are administered:

For Anaphylaxis: Adrenaline 1/1000 (1mg/ml) for Intra-muscular use ONLY or auto injector (where agreed)

For Opioid Overdose: Drug and alcohol teams must hold Naloxone 2mg/2ml for emergency use.

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9.7.3 Medicines Summary Table The table below has been developed to help clarify which wards and units should hold these medications, and who is expected to administer them, and whether they need to be prescribed for nursing staff to administer.

Please refer to the BNF for the most up-to-date information on indication and dose. Medication All All Category A ECT Categ Who can administer? Category acute care suite ory B A areas inpatient units that areas Nurse can Doctor have access to administer can junior doctors and administer the junior doctor on call rota Actrapid ✓ (S.C. but Insulin only under the direction of a doctor’s prescription) Adrenaline 1 ✓ ✓ (can be in (only given in an 1000 where emergency (1mg/ml) vaccines for the intramuscular are management injection administ of ered) anaphylaxis without a prescription) Aspirin (under the 300mg tablet direction of a doctor or the ambulance crew) Chlorphenam (via I.M. ine injection route under 10mg/ml the direction of a doctor’s prescription) Diazepam (under the rectal direction of a solution doctor’s prescription) Flumazenil X (as can injection only be given 100mcg/ml by I.V. route) Glucagon (via I.M. route under

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9.8 Ordering, Location, Checking and Maintaining Medical Emergency/Resuscitation Equipment and Medication 9.8.1 Medical emergency or resuscitation equipment for the Trust will be ordered through the SBS procurement process. See appendix 5 - How to order green bag consumables, for further information on how to do this.

9.8.2 Emergency drugs including anaphylaxis packs and oxygen will be supplied via the Trust pharmacy department.

9.8.3 Ward/unit managers must ensure the equipment is sited in an accessible place, kept together; and that all staff, including locum, agency and bank staff are aware of its location. This must be included in local ward/unit induction.

9.8.4 Ward/unit managers must ensure that the medication is stored in a dedicated locked cupboard with a list of contents attached (including items to be refrigerated), and that all staff, including locum, agency and bank staff are aware of its location. This must be included in local ward/unit induction.

9.8.5 The ward/unit manager is accountable for ensuring that all medical emergency and resuscitation equipment is checked each week by an appropriate member of staff and signed for using appendix 6 or the Meridian online process. Any missing items must be replaced as soon as possible and the Medical Emergency Equipment Compliance Coordinator informed

9.8.6 The ward/unit manager(s) is accountable for ensuring that the medication is checked each week (to include availability, expiry date and condition) by an appropriate member of staff, and signed for using Appendix 6 or Meridian online process. Any missing items must be replaced as soon as possible and the Medical Emergency Equipment Compliance Coordinator informed

9.8.7 Paper documentation of the checking procedure will be kept in a file at ward/unit level for audit purposes.

9.8.8 Ordering of medication will be undertaken by a qualified nurse when: Page 25 of 55

• Medication has been used • Medication has date expired • Medication has been opened and stability cannot be assured

9.8.9 Pharmacy staff will continue to monitor and order medication if required as part of routine top up, referring any issues to the ward/unit manager.

9.8.10 Any faults with medical emergency and resuscitation equipment must be reported immediately to the ward or unit manager AND the Medical Emergency Equipment Compliance Coordinator, so that appropriate action can be taken and replacement organised immediately.

9.8.11 Defibrillators will be listed on the Medical Devices asset register and checked annually under the asset register audit.

9.9 Infection Control To prevent the risk of transmission of infection all personnel working within the Trust must ensure they have access to face shields or pocket masks prior to providing ventilatory support to individuals; clinical gloves must be worn and aseptic procedures followed where applicable.

9.10 Do not attempt cardio-pulmonary resuscitation (DNACPR) 9.10.1 For every person there comes a time when death is inevitable; it is essential to identify individuals for whom attempted CPR is inappropriate. It is also essential to identify those individuals who do not want CPR to be attempted and who competently refuse it. An over-arching principle of this process is that people who use our services and their families are involved in the decision making process and the outcome of the decision is communicated to the person using our services and / or families and the health care team.

9.10.2 Guidance from the Resuscitation Council (UK) which includes input and statements from the British Medical Association and the Royal College of Nursing entitled “Decisions relating to cardiopulmonary resuscitation; Guidance from the British Medical Association, the Resuscitation Council (UK), and the Royal College of Nursing 2016 Page 26 of 55

(previously known as the HSC2000/028 "Joint Statement") informs this policy, and all staff involved in DNACPR should follow these guidelines. Surrey & Borders Partnership Foundation NHS Trust will ensure that individuals’ rights are respected and central to any decision-making relating to CPR or DNACPR.

9.10.3 The purpose of these guidelines is to make clear the process regarding any advance decision (as covered in the Mental Capacity Act 2005) that an individual should not receive attempted CPR. These guidelines apply only to an individual who suffers a cardio-respiratory arrest. All other treatments, interventions and nursing care MUST not be precluded or influenced by a decision not to attempt resuscitation.

9.10.4 Cardiopulmonary Resuscitation (CPR) will be attempted on any individual in whom cardiac function suddenly ceases and who at the time is on the premises of the Trust or in the direct care of Trust staff.

The only exception to this is:

Where a valid Do Not Attempt Cardiopulmonary Resuscitation decision has been made by a Clinician in accordance with the guidelines published by the Resuscitation Council UK - “Decisions relating to cardiopulmonary resuscitation; Guidance from the British Medical Association, the Resuscitation Council (UK), and the Royal College of Nursing” (2016)

9.10.5 This order only applies to cardio-pulmonary resuscitation attempts and bears no reflection on the decision to administer any other treatments or care.

9.10.6 A DNACPR decision remains valid until it has been reviewed as part of that persons’ clinical review by a multi-disciplinary team and can be either continued or, if appropriate, withdrawn at any time (i.e. resolution of a previous critical medical event or the persons desire to withdraw the DNACPR)

9.10.7 DNACPR decisions must be reviewed as part of the Trust process for clinical review of anyone who enters our Services and already has a DNACPR order.

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9.10.8 If the resuscitation status of a person using our services is unknown then resuscitation must and will be initiated.

9.10.9 People using our services requesting not to be resuscitated must be assessed at the time in accordance with the Mental Capacity Act 2005 and Doctors/Consultants may wish to refer to Guidance from the BMA’s Medical Ethics Department document “Advance decisions and proxy decision-making in medical treatment and research” (2007). The advance decision to refuse treatment MUST be clearly documented and communicated to all members of the team involved in their care. Clinicians must ensure the individual and/or families have a clear understanding of the Do Not Attempt Cardiopulmonary Resuscitation order. A copy of this policy must be made available to the person who uses our services and / or their families.

9.10.10 t is the responsibility of the Consultant in charge, or the most Senior Clinician responsible for the multi-disciplinary team (MDT) looking after the Service User to decide whether a DNACPR decision is appropriate. A DNACPR order should be made in a holistic manner, involving all members of the MDT, Person who uses our Services and/or their relatives

9.10.11 The decision not to resuscitate must be communicated to the person who uses our service and/or their relatives verbally and then clearly documented, signed and dated in case-notes.

9.10.12 Where people who use our services are not to be consulted, it will be necessary for the Consultant to demonstrate that to involve the individual is likely to cause the individual a degree of harm. Distress itself is insufficient. The reasons for this decision should be recorded in the case record.

9.10.13 Where individuals lack capacity and have made an advance decision to refuse treatment not to be resuscitated, as specified under the Mental Capacity Act, staff are bound to abide by that decision as long as it is valid and applicable.

9.10.14 Guidance on Advanced Directives and their validity should be sought from the BMA’s Medical Ethics Department document “Advance decisions and proxy decision-making Page 28 of 55

in medical treatment and research” (2007) and the Mental Capacity Act 2005, c.9, part 1 “advanced decisions to refuse treatment”

9.10.15 All individuals have the right to expect appropriate resuscitation in the event of cardiac arrest.

9.10.16 When a Do Not Attempt Cardiopulmonary Resuscitation order is made a Do Not Attempt Resuscitation form (Appendix 2) must be completed by the responsible clinician and scanned into the persons notes. DNACPR forms are transient and the original must accompany the person wherever they go – If appropriate the Do Not Attempt Resuscitation red form (appendix 2) can be handed to the person using our services, otherwise it must remain with their clinical records and preferably at the front or clearly marked otherwise.

9.10.17 The Do Not Attempt Cardiopulmonary Resuscitation form must be completed in full stating the decision for not resuscitating the person using our services and the rationale pertaining to that documented.

9.10.18 No abbreviations are acceptable or may be used within the contents of the Do Not Attempt Cardiopulmonary Resuscitation Order.

9.10.19 Advance decisions to refuse treatment must be clearly documented on Do Not Attempt Cardiopulmonary Resuscitation form.

9.10.20 Do Not Attempt Cardiopulmonary Resuscitation must be communicated to all health care professions and reiterated at nursing handover, ward rounds and team meetings.

9.10.21 If the Consultant concludes that the form of treatment requested following consultation, is not clinically indicated, they are not under legal obligation to provide the treatment. However, the DNACPR notice should not be placed on the person’s record and a clinical judgement will have to be made at the time of deterioration as to the treatment (including resuscitation) to be provided.

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9.10.22 Whilst there is no legal obligation to offer a second opinion, good practice requires that the opportunity is available for individuals to obtain a second opinion if they so wish.

9.10.23 Personnel involved in the making of a Do Not Attempt Cardiorespiratory Resuscitation order should ensure they are familiar with the guidance from the Resuscitation Council (UK) which includes input and statements from the British Medical Association and the Royal College of Nursing titled “Decisions relating to cardiopulmonary resuscitation; Guidance from the British Medical Association, the Resuscitation Council (UK), and the Royal College of Nursing 2016 (previously known as the HSC2000/028 "Joint Statement")

9.11 Post – Incident Debriefing Post-incident debriefing has two major parts: Clinical and Psychological/Mental Health well- being. Clinical debriefing as soon as practically possible after the incident MUST be undertaken and should be arranged by contacting the RMEO (Resuscitation and Medical Emergencies Officer). Mental health support and debriefing should be coordinated through the Serious Incident Support Team (SIST) for all staff involved, whether directly or indirectly affected.

9.12 Cardiac Arrest Audit and Monitoring 9.12.1 All resuscitation attempts, whether successful or not, will be reported as an incident using the trust incident reporting process.

9.12.2 In the event of resuscitation being carried out the Trust incident form must be completed.

• This is intended to give uniform reporting of arrests which can be used for auditing, debriefing of staff in which support can be provided and matters of concern raised and evaluation of training needs. • The person in charge should complete the form before leaving the resuscitation scene. Note must be taken at the time of the arrest including timings of events.

9.12.3 All cardiac arrests will be considered as serious incidents and therefore will be Page 30 of 55

reported through the incident reporting process except when a person using our services is ill and death is expected in older adult units.

9.12.4 The RMEO must also carry out an audit, utilising the downloadable information from the AED and staff clinical debriefing. A report must be made available for required stakeholders, inc. the Legal Team and potentially HM Coroner.

9.13 Unannounced Medical Emergency/Cardiac Arrest Drills 9.13.1 Annual ‘drills’ will be conducted in Category A sites by the RMEO and appropriate Resuscitation Council UK BLS/ILS Instructors from the Education Department. These will include an assessment of staff competency in basic or immediate life support, or both, and access and availability of equipment including checking the green bag, expiry dates of equipment and contents of the oxygen cylinders.

9.13.2 A report and action plan following the drills will be generated and supplied to the Ward/unit Manager, Service Manager and the Trust Resuscitation Lead for Information as well as any plans for immediate action that the RMEO deems necessary.

9.13.3 The RMEO will report any defects in equipment to the Medical Emergency Equipment Compliance Coordinator to arrange rapid repair or replacement as required.

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10.0 Monitoring Table What will be Deficiencies / gaps How/ Method Frequency Lead Reporting to monitored recommendations and actions Quality Assurance Director of Non-compliance will be Reported All Resuscitation Committee via the Datix Report Annual Risk and to the relevant Divisional Director incidents Resuscitation Steering Safety for them to take appropriate action Group Director of Quality Assurance Non-compliance will be Reported Use of a modified early Audit Annual Risk and Committee via the to the relevant Divisional Director warning system Safety Safety Hub for them to take appropriate action Quality Assurance Director of Non-compliance will be Reported Do not resuscitate Committee via the Audit Annual Risk and to the relevant Divisional Director orders (DNAR) Physical Health Safety for them to take appropriate action Steering Group Documentation to Quality Assurance support that Director of Non-compliance will be Reported Committee via the resuscitation equipment Local audits Quarterly Risk and to the relevant Associate Director Resuscitation Steering is checked, stored, and Safety for them to take appropriate action Group fit for use Quality Assurance Director of Non-compliance will be Reported Committee via the Effectiveness of policy Drills programme Annual Risk and to the relevant Associate Director Resuscitation Steering Safety for them to take appropriate action Group

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Equality Analysis

The equality analysis guidance notes and template are provided to support you in meeting the requirements of the Public Sector Equality Duty which came into force on 5 April 2011. You should use this template to record evidence that equality analysis has been carried out before policy decisions take place. The form is a written record that demonstrates that you have shown due regard to the need to eliminate unlawful discrimination, advance equality of opportunity and foster good relations with respect to the characteristics protected by equality law.

1. About the policy/project/change

Title of the policy / project / change: Managing Medical Emergencies including Resuscitation and Anaphylaxis What are the intended outcomes / To update policy to ensure it is up-to-date changes expected as a result of this and compliant with Resusciation Council policy / project / change: (UK) Guidelines, NICE Guidelines and Trust Clinical Procedures Are there links with other existing Learning and Development, Medicines policies/projects: Policy, Clinical Risk Management Policy, (if yes – provide details) Health & Safety Policy

2. Decide if the policy / project / change is equality relevant

Does the policy/project involve, or have This policy is equality relevant consequences for people using services, carers, as it involves and has employees or other people? If yes, please state the consequences for people who groups of people who are likely to be affected. use our services, carers and If yes, then the policy/project is equality relevant. If employees. no, you can skip to section 6. However the majority of Trust policies and projects are equality relevant because they affect people in some way.

3. Gathering evidence to inform the equality analysis What evidence have you gathered to help inform this analysis? This can include evidence from national research, surveys & reports, interviews and focus groups, policy monitoring and evaluations from pilot projects, etc. If there are gaps in the evidence available under any of the characteristics, please explain why this is the case and state what actions will be taken to close the gaps as part of the action plan. Please ensure you check Annex C of the guidance notes for sources of evidence.

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The Protected Characteristics & Evidence Using the relevant available evidence - what is known, understood or assumed about each of the equality groups / protected characteristics identified below that could be relevant to this policy / project / change. Record the sources of the evidence used for all the protected characteristics Equality Act, Mental Health Code of Practice, Human Rights Act

4. Engagement and Involvement

Record the names of the people and/or groups involved in gathering evidence and/or testing the evidence against the policy / project / change. Who and how were they involved? Who – name of individual / group(s) How have these people been involved – represented e.g. meeting Resuscitation Council Meeting – September 2018

5. Analysis of the potential impact of the policy / project / change Based on the evidence you have gathered; describe any actual or likely impacts that may arise as a result of the decision and whether these are likely to be positive or negative. Where actual or likely impacts are identified, you should also state what actions will be taken to promote the likelihood of positive impacts as well as minimise or mitigate against possible or likely negative impacts, i.e. what can the Trust reasonably do to actively manage the consequences of its decision / action

Eliminate discrimination, harassment and victimisation: Does the policy / project / change, help eliminate discrimination, harassment and victimisation in any way? If yes, provide details. If no, provide reasons Age Caring responsibilities Disability Gender reassignment Marriage & civil The policy is applied equality across all groups and as partnerships such will work to eliminate the feeling of victimisation or Pregnancy & maternity discrimination for all groups. Race / ethnicity Religion or belief Sex / gender Sexual Orientation

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Advance equality of opportunity: Does the policy / project / change, help develop equality of opportunity in any way? This could include removing or minimising disadvantages suffered by people due to their protected characteristics, taking steps to meet the needs of people from protected groups where these are different from the needs of other people, or encouraging people from protected groups to participate in activities where their participation is disproportionately low. If yes, provide details. If no, provide reasons Age Caring responsibilities Disability Gender reassignment The policy does not advance equality of opportunity for Pregnancy & maternity any group but ensures a fair approach to undertaking the Race / ethnicity tasks outlined Religion or belief Sex / gender Sexual Orientation

Promote good relations between different groups: Does the policy / project / change, help foster good or improved relations between different groups in any way? If yes, provide details. If no, provide reasons. Age Caring responsibilities Disability Gender reassignment The policy will promote good relations between groups Pregnancy & maternity because it brings clarity to what is expected of staff and Race / ethnicity all people involved Religion or belief Sex / gender Sexual Orientation

What do you consider the overall impact: Considering the combined impact of the analysis and the actions required to promote the likelihood of positive impacts and minimise or mitigate against potential negative outcomes – does the analysis support the implementation of the policy / project / change? This policy and procedures ensure groups are treated equally due to the clarity of process outlined in this document

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6. Action Planning

Actions to be taken as a result of this analysis Name of person Date action (add additional rows as required): who will take this due to be action completed 1. 2. 3. 4. 5.

7. Authorisation

Name & job title of person completing this Paul Luker analysis: Date of completion: 08/12/2018 Name & job title of person responsible for Director of Nursing monitoring and reporting on the implementation of the actions arising from this analysis: Name & job title of authorised person: Director of Nursing (If there are doubts about the completeness or sufficiency of this equality analysis, seek advice from the Equality and Human Rights Team or the Legal Services & Reporting Manager in the Clinical Risk & Safety Team) Date of authorisation: 08/12/2018

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Appendices

Appendix 1 Early Warning Scoring System

Appendix 2 Do not attempt Cardiopulmonary Resuscitation Patient Record (Red form)

Appendix 3 Resuscitation Protocol

Appendix 4 Adult BLS (where there is no defibrillator)

Appendix 5 How to order green bag consumables

Appendix 6 Checklists

Appendix 7 Summary of site/staff training and equipment requirements

Appendix 8 Psychological Defusing (Serious Incident Support Team)

`

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Appendix 1

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Appendix 2

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Appendix 3

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Appendix 4

To be followed by services where there is no defibrillator, or until defibrillator and green bag (where available) arrive

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Appendix 5 How to order Green Bag Consumables

Log into SBS, open your IProc menu, you will see the below screen Click, Green Bag Consumables

You will see the below screen. Each item in the Green bag is listed as shown

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The list is continued, click the arrow as shown below to view further items available

Click on the item you require as below

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You can then enter the quantities that you require and select the delivery charge, as shown below.

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Once you are happy with the quantity and delivery charge, select add to cart You can check out,

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Or to continue to add further items from the same list repeat the above. Your cart will continue to fill up. Once you are happy with the items you can check out as normal. For Defibrillator consumables please check the IProc catalogue, the items will be available to order.

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Appendix 6 Category A - Resuscitation Adjunct Kit Contents to be Checked Weekly by a Qualified Nurse Ward/Unit ………………………………………………………………………………………………………

Green Bag Contents Equipment Date Full Name Designation Comments Checked 1 x Portable hand held suction ( battery or manual) with Yankauer sucker and soft suction catheters 1 x Oxygen cylinders should now all be ones that have been supplied by SABP pharmacy) Self inflating bag with reservoir, and oxygen tubing Ambu bag) Clear face mask sizes 3,4,5 Oxygen mask with reservoir and oxygen tubing

1 x Set oropharyngeal Airways (sizes 2, 3, 4,)

Supraglottic airway devise with syringes , lubrication and ties/tapes/scissors as appropriate

Pocket Mask with oxygen port and oxygen tubing

Ligature Cutters

Magill forceps

Ward manager to confirm this has been completed:

Print Name………………………………………………………………………… Date…………………………………………………

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The Defibrillator Case (Each defibrillator should have the data download cable kept with it)

Equipment Date Full Name Designation Comments Checked Defibrillator with a green rescue ready light indicator, with a set of in date electrodes connected.

Spare in date electrodes

A high absorbency towel

A surgical non-clog razor (BIC like razor is not acceptable)

Tuff cut scissors

Adhesive tapes

Dressing packs

Gloves /aprons/eye protection Is ABCDE checklist attached to the green bag

Is Resuscitation Flow Chart attached to the green bag and displace in the office and clinical room

Ward manager to confirm this has been completed:

Print Name………………………………………………………………………… Date…………………………………………………

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Category A sites that have access to junior Doctors on-call – Emergency Medicines to be Checked Weekly by a Qualified Nurse Ward/Unit ………………………………………………………………………………………………………

Ward Emergency Medicines Cupboard Contents All emergency drugs listed must be checked on a weekly basis Any listed drugs that are not available for use must be replaced immediately. Check: • Drug available • Drug in date • Drug in original container; e.g. no loose Date ampoules Checked Full Name Designation Comments • Drug stored in appropriate location; e.g. Adrenalinefridge 1 initems 1000 injection Aspirin 300mg tablets Chlorphenamine injection 10mg/ml Diazepam rectal solution Flumazenil injection 100 micrograms /ml Glucose oral gel (Hypostop, Dextrogel) Glyceryl Trinitrate spray 400 micrograms

Hydrocortisone succinate injection 100mg Naloxone injection 400micrograms/ml Procyclidine injection 5mg/ml Salbutamol evohaler 100micrograms Salbutamol 5mg nebules Water for injection Drug Fridge Actrapid insulin vial Glucagon injection 1mg/ml

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Category A sites that do not have access to junior Doctors on-call – Emergency Medicines to be Checked Weekly by a Qualified Nurse Ward/Unit ………………………………………………………………………………………………………

Ward Emergency Medicines Cupboard Contents All emergency drugs listed must be checked on a weekly basis Any listed drugs that are not available for use must be replaced immediately. Check: • Drug available • Drug in date • Drug in original container; e.g. no loose Date ampoules Checked Full Name Designation Comments • Drug stored in appropriate location; e.g. fridge items Adrenaline 1 in 1000 injection

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ECT suit– Emergency Medicines to be Checked Weekly by a Qualified Nurse Ward/Unit ………………………………………………………………………………………………………

Ward Emergency Medicines Cupboard Contents All emergency drugs listed must be checked on a weekly basis Any listed drugs that are not available for use must be replaced immediately. Check: • Drug available • Drug in date • Drug in original container; e.g. no loose ampoules Date • Drug stored in appropriate location; e.g. Checked Full Name Designation Comments fridge items Adrenaline 1 in 1000 injection *Cardiac arrest box *The Cardiac Arrest Box must be easily and quickly accessible and therefore it is not necessary to lock away in a cupboard

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Category B sites Drug and Alcohol services – Emergency Medicines to be Checked Weekly by a Qualified Nurse Ward/Unit ………………………………………………………………………………………………………

Ward Emergency Medicines Cupboard Contents All emergency drugs listed must be checked on a Date Full Name Designation Comments weekly basis Checked Any listed drugs that are not available for use must be replaced immediately. Check: • Drug available • Drug in date • Drug in original container; e.g. no loose ampoules • Drug stored in appropriate location; e.g. fridge items Adrenaline 1 in 1000 injection Naloxone prefilled syringe 2mg/2ml

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Appendix 7 Summary Table

Category A Training Equipment Medicines (stored in Records dedicated cupboard with list of contents on outside) Inpatient ward All SABP • AED All emergency medicines Weekly with access to qualified • Green bag listed in document check junior doctor nursing and +oxygen on call medical Staff to • Resus No fluids undertake boards annual ILS All other health Inpatient ward All SABP • AED Adrenaline for Weekly care staff to without access qualified Green bag anaphylaxis only check undertake at • to junior doctor nursing and + oxygen on call medicalleast annual Staff to BLS+ AED • Resus undertake boards annual ILS HTT where staff All SABPother health Use ward Use ward medicines N/A are collocated qualifiedcare staff to equipment with Acute nursingundertake and at inpatient medicalleast annual Staff to services undertakeBLS+ AED annual ILS All other health ECT All SABP Staff to • AED Adrenaline for Weekly care staff to undertake Green bag anaphylaxis only check undertake at • annual ILS + oxygen least annual SLA provider Full cardiac resus box for staffBLS+ qualified AED to use by SLA provider staff ALS level (Anaesthetist and ODP) Drug and All SABP • AED Adrenaline for Weekly alcohol qualified • Green bag anaphylaxis only check services nursing and + oxygen community medical Staff to Naloxone teams undertake prefilled injection annual ILS 2mg/2ml All other health care staff to undertake annual BLS + AED

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Summary Table (cont’d)

Category B Training Equipment Medicines Records Social All care staff to • Pocket face Adrenaline for weekly care undertake mask anaphylaxis only (to be homes annual BLS + • AED provided by district AED • Resus nurse as part of flu vac Boards programme) Respite homes All care staff to • Pocket face Adrenaline for anaphylaxis Weekly undertake annual mask only BLS and AED • AED • Resus Boards Community All care staff to • Pocket face None N/A HUBS undertake annual mask BLS and AED • AED

Community All care staff to • Pocket face None N/A Teams undertake annual mask BLS and AED

HTT not All care staff to • Pocket face None N/A connected with undertake annual mask Acute inpatient BLS and AED services

Specialist Training Equipment Medicines Records Services Custody All care staff to • Pocket face None N/A undertake annual mask BLS and AED

Forensic All care staff to • Pocket face None N/A undertake annual mask BLS and AED

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Appendix 8

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