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 Page 2 of 55 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 Page 3 of 55 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 Page 4 of 55 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) Page 5 of 55 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 Page 6 of 55 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” Page 7 of 55 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.