CPOL15 Cardiopulmonary Resuscitation v7 with COVID warning Box by Provide Community

Cardiopulmonary Resuscitation (CPR)

Adults & Children

Version: V7

Ratified By: Quality & Safety Committee

Date ratified: 28/01/2021

Job Title of Author: Head of Quality and Safety

Reviewed by Sub Group or Expert Group: Clinical Reference Group

Equality Impact Assessed by: Head of Quality and Safety

Covid 19 Update

During the Covid 19 pandemic the UK Resuscitation Council have made the following interim recommendations in relation to Cardio Pulmonary Resuscitation (CPR) in non-acute settings and community.

CPR must not be delayed due to the absence of an FFP3 mask For adults – chest compressions only should be undertaken, the mouth and nose of the patient should be covered with a spare mask/tissue or cloth prior to commencing chest compressions. Continue to seek help and initiate chest compressions as per the process within this policy. Community inpatient wards have access to Ambu bags and FFP3 masks on the resus trolleys however CPR (chest compressions) should be commenced while these are assembled. For children and babies – if there is no known Covid +ve status, breathes and chest compressions are still advised as per this policy. Research indicates that this group are more likely to be experiencing respiratory arrest and benefit from combined breaths and chest compression.

1. Introduction

The Resuscitation Council (UK) launched new guidelines for cardiopulmonary resuscitation in 2015. The guidelines are accredited by the National Institute for Health & Care Excellence and were developed in conjunction with the European Resuscitation Council for adaption in the United Kingdom. The guidelines were also peer reviewed by the Executive Committee for the Resuscitation Council (UK).

The changes in the 2015 guidelines compared with the previous 2010 guidelines are relatively subtle. Nevertheless, some of the treatment recommendations in these guidelines will change the way resuscitation is delivered. The 2015 guidelines now incorporate and advocate the use of Automated External Defibrillator (AED) devices as part of the resuscitation process.

This policy draws on recommendations of the Royal College of Nursing, British Medical Association and the Resuscitation Council (UK) and with consideration of the resources available sets the Cardiopulmonary Resuscitation (CPR) Standards for Provide.

2. Purpose

As a Healthcare Organisation Provide has an obligation to provide a resuscitation policy to ensure that staff are trained and updated regularly to a level of proficiency appropriate to each individual’s expected role.

This policy sets out the principles by which Service Users being treated by Provide who suffer a cardiac arrest are managed in line with the Resuscitation Council 2015 Guidelines. This policy will always be applicable in the absence of any ‘Do Not Attempt Cardiopulmonary Resuscitation Decision”.

To achieve an optimal outcome from cardiac arrest it is essential to have staff who are trained in early recognition and call for help and early defibrillation.

All clinical and public areas where a cardiac arrest may occur must have adequate resources available which are clearly visible. All cardiac arrest equipment where available must be checked on a regular basis as set out within this policy and also after any use. Staff should familiarise themselves with the equipment available and its location when working in these areas.

Survival and wellbeing will be optimised by having appropriately trained staff and a robust system in place for alerting emergency teams. All staff with clinical roles are required to have annual Basic Life Support (BLS) training. Trained Clinical staff working on Wards are required to have Immediate Life Support (ILS) training which also applies to the Cardiac Rehabilitation and Respiratory Teams.

Paediatric Nursing Staff must all undertake paediatric resuscitation training.

As Healthcare Providers it is unacceptable for people who exhibit symptoms of a cardiac arrest to await the arrival of an ambulance service before basic life support is performed and a defibrillator is available. This policy sets out the expectation for all staff trained in resuscitation. In all cases of CPR within Provide services, patients who suffer cardiac arrest will be transferred via 999 Emergency Transport for further treatment to an appropriate Accident & Emergency Department for specialist care and treatment.

Where there is no time to establish the medical history and/or in the absence of a prior decision not to resuscitate (DNACPR), CPR must be initiated. This is in accordance with both professional responsibilities and legal obligations of clinical staff. Failure to attempt CPR based on assessment of the patient’s condition by a Practitioner, who is not in possession of the appropriate information, may result in legal action against the Practitioner and/or the Organisation.

3. Purpose, Aim & Scope

Purpose

The purpose of this policy is to provide a framework, which supports professional practice, ensuring all members of staff who have contact with patients are trained and equipped, to a level appropriate for their expected role to resuscitate patients who suffer a cardiac arrest.

Aims

To optimise patient care and outcomes to reduce mortality and morbidity of people who have suffered a cardiac arrest by:

• Providing direction and guidance for the delivery of robust and high-quality resuscitation response across the Organisation.

• Ensuring that safe, early and appropriate CPR occurs within the Organisation, this will include defibrillation.

• Detail the training requirements for all staff in the Organisation regarding CPR and post resuscitation care.

• Detail the tools utilised across the Organisation for identification of people at risk of deterioration and cardiac arrest.

• Detail the process for continual availability of cardiac arrest equipment, maintenance and location.

• Detail the monitoring of compliance with all of the above points.

Scope

The application of this policy is for Provide clinical staff.

Staff not clinically trained are not legally obliged to undertake basic life support. Clinically trained staff are required to perform basic life support and where mandated as appropriate to their role immediate life support and paediatric resuscitation.

4. Roles, Responsibilities and Accountability

Chief Executive

The Chief Executive has overall accountability for the strategic direction and operational management of Provide including ensuring that policies are in place that comply with all legal statutory and good practice guidance requirements. The Chief Executive is accountable for ensuring the provision of resources and access to adequate training to all appropriate Provide staff.

Assistant Directors

Assistant Directors are responsible for promoting this policy to staff. Other responsibilities include:

• Bringing the policy to the attention of all appropriate staff within their areas of responsibility

• Receiving and actioning training and non-compliance

• Ensuring that staff have the necessary training to fulfil their specific roles within the Organisation

• Ensuring that appropriate staff attend the mandatory CPR Training annually

• Ensuring immediate action is taken following receipt of resuscitation related risk assessments

• Ensure that all areas have adequate CPR equipment in place and systems for maintenance (if applicable)

Employees, Independent Contractors & Agency or Workforce Solutions Clinical Staff

This group of staff are responsible for

• Compliance with relevant policies and supporting documents. Recognition of failure to comply with this policy may result in disciplinary action being taken

• Follow relevant professional code of conduct

• Attend mandatory annual relevant training and maintain competencies; agency staff are expected to obtain training through their relevant agencies

• Keep up to date patient records

• Report all CPR attempts as a critical incident as set out in this policy

• Contribute to any CPR Incident Investigation and subsequent actions

• Initiate the level of life support appropriate to their training and dial 999

• Use the equipment available where indicated and ensure faulty/missing equipment is promptly reported

Provide

Provide is responsible for:

• Coordinating provision of resuscitation training

• Investigation of all incidents of cardiopulmonary resuscitation through the Incident Reporting Process

• Reporting any subsequent audit through the Quality & Safety Committee and Clinical Excellence Group

• Purchase and maintain defibrillation equipment.

5. Training

All clinical staff, directly employed by Provide will have mandatory training updates given by a suitably qualified Resuscitation Officer. This includes the use of Automated External Defibrillators (AEDs) for appropriate staff groups, and any new developments and guidelines are incorporated into BLS training and education.

Provide has developed appropriate training programsfor clinical staff. It is the responsibility of staff to ensure they attend training according to the mandatory training requirements of their staff group. It is the responsibility of Managers and Team Leaders to ensure that training is carried out according to those mandatory requirements. If a staff member is unable to attend training, for whatever reason, it is the staff member’s responsibility to inform the Learning & Development Team and make alternative training arrangements. The staff member is also responsible for informing their Manager/Team Leader of the changes and reasons for change.

A register of staff trained in CPR will be kept on the Learning & Development teams Database. A list of attendance levels will also be maintained. CPR training should comply with the Resuscitation Council Guidelines (2015 and subsequent further guidelines).

It is the responsibility of each Manager to ensure that training is attended by all staff at an appropriate time. However, qualified staff have a professional obligation to ensure that they are adequately trained and competent to perform BLS and defibrillation where an AED is deployed.

Training to use an AED includes the following:

• Importance of and definition of defibrillation

• Resuscitation Council Guidelines/Protocols

• Recognition of cardiac arrest

• Safety of the patient, operator and other staff

• Placement of electrodes

• Demonstration of correct defibrillation technique

• Practice – allowing each student time to run through at least one total procedure from start to finish

• Cardiac arrest management scenarios to include basic life support, airway management, cardiac arrest rhythm recognition and defibrillation

• Pass Resuscitation Council (UK) Competencies for automated external defibrillation.

All staff must achieve a minimum standard of ability to be considered competent for the year.

Agency and locum staff are not included in the resuscitation training program. Therefore, they are individually responsible for remaining appropriately trained for the role that they are employed and must provide evidence of this when requested. However, Workforce Solutions staff who are directly employed by Provide are covered by this CPR Policy. If staff identify that Agency or Locum Staff are not appropriately resuscitation trained, this must be escalated through existing governance processes.

6. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)

Adults

Survival following cardiopulmonary arrest in adults is between 5-20%, dependent on the cause of the arrest. When adults have an acute event, such as a myocardial infarction they may recover following CPR. However, the chances of survival are much lower for people who have a cardiopulmonary arrest due to a progressive illness or life limiting condition.

80% of cardiac arrests occur outside of hospital and 90% of these will result in death.When cardiac arrest occurs in hospital 13-17% survive to hospital discharge but many have long term disabilities.

CPR could be attempted on all individuals where cardiac or respiratory functions stop, cessation of these is an inevitable part of dying. It is therefore essential that staff are able to identify people in their care for whom cardiac arrest represents the terminal event in their illness and for whom resuscitation would be inappropriate.

All individuals have the right to die with dignity and respect and so it is important that Do Not Attempt CPR decisions are in place for appropriate individuals and that this decision is based around medical and clinical assessment in conjunction with the individual and their family. It is Provide’s policy that all persons suffering a cardiac arrest are for CPR unless otherwise stated as in a DNAR Document.

Provide have chosen to follow National Guidance in this area recommended by NHS England, CPOL37 NHS England Integrated Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Policy for Adults.

Do Not Attempt Cardiopulmonary Resuscitation – Mental Capacity Act

All Clinicians are expected to be familiar with the Mental Capacity Act (MCA) principles, understand the MCA, how it works in practice and the implications for people for whom a DNACPR decision has been made.

Staff working with people lacking capacity for whatever reason should be familiar with the MCA Code of Practice and follow the guidance. The MCA lays down a framework that must be followed when services are working with people who may, permanently or temporarily, lack the capacity to make all, or some, decisions about their treatment and care for themselves. The MCA gives rights to Service Users and those who it represents and responsibilities to staff and others working with them.

The MCA places the person who lacks capacity at the centre of decision making, ensuring their choices are respected and that decisions made for them are in their best interests. The MCA does not fully define ‘best interests’ but it does give a checklist.

If the person does not have capacity, their relevant others must be consulted to establish what the decision maker reasonably believes the person would decide if able to do so. If the person has made a Lasting Power of Attorney (LPA) appointing a Welfare Attorney to make decisions on their behalf, that person must be consulted. A Welfare Attorney may be able to refuse life-sustaining treatment on behalf of the person if this power is included in the original LPA. You need to check this by reading the LPA. If there is no one appropriate to consult with and the person has been assessed as lacking capacity then an instruction to an Independent Mental Capacity Assessor (IMCA) should be considered.

Staff should follow SGPOL10 Mental Capacity Act Policy v5 when uncertainty around capacity and consent exist.

Children & Young People under the Age of 18 Years

Ideally, clinical decisions relating to children and young people should be taken within a supportive partnership involving the patient, parents and Healthcare Team.

As with adults, decisions about CPR must be made on the basis of an individual assessment of each child or young person’s current situation. It is not necessary to initiate discussion about CPR if there is no reason to believe that the child is likely to suffer cardiac arrest.

Usually, it is possible to reach agreement on whether or not CPR should be attempted. If it is not possible to reach agreement between the child, the individuals with parental responsibility and the Healthcare Team, legal advice should be sought. Doctors cannot be required to provide treatment contrary to their professional judgement, but Doctors should

try to accommodate the child/young person and parents’ wishes where there is genuine uncertainty about the child/young person’s best interests. If legal advice is required, this must be sought in a timely manner.

Where a competent child/young person makes an informed advance refusal of CPR, Healthcare Professionals should seek legal advice if they believe that CPR would be beneficial to the child/young person. In England, refusal of treatment by a competent child/young person up to the age of 18 years is not necessarily binding upon Doctors.

As noted above, a child/young person’s refusal is not necessarily binding but children/young people who are competent to do so are entitled to give consent to medical treatment.

Where they are not competent it is generally those with parental responsibility who make decisions on their behalf. Young People 16 years of age and over are assumed to be competent to consent to medical treatment unless there is evidence to the contrary.

Children/young people under the age of 16 years can also be assessed to be competent to consent to medical treatment. Competent children/young people who are under the age of 16 years are sometimes referred to as being Fraser Competent. QSPOL07 Policy for Consent to Examination or Treatment V8 outlines the processes for consent for adults and children.

7. Record Keeping

For both adults and children/young people it is essential that all decisions in relation to any individual’s care are recorded in detail within the patient’s primary record and that sharing agreements are used to ensure that the Multidisciplinary Team are aware of decisions as soon as possible after they are made.

Decisions related to DNACPR should be completed on the unified DNACPR form and held by the patient. Details of this form and its location should be documented on the patient’s clinical record.

8. Resuscitation Procedures

Initial Management of Cardiac Arrest

Adult Resuscitation

Actions

1. Ensure Patient Safety

• There are very few reports of harm to rescuers during resuscitation

• Your personal safety and that of Resuscitation Team Members is the first priority during any resuscitation attempt

• Check that the patient’s surroundings are safe

• Put on gloves as soon as possible. Other Personal Protective Equipment (PPE) (eye protection, face masks, aprons, and gowns) may be necessary, especially when the patient has a serious infection such as tuberculosis. Follow local Infection Control Procedures to minimise risk

• Be careful with sharps; staff should follow IPPOL18 –Management & Safety of Sharps V4

• Use Safe Handling Techniques for moving victims during resuscitation. The Resuscitation Council (UK) has produced Guidance for Safer Handling during Cardiopulmonary Resuscitation in Healthcare Settings.

2. Check the Patient for Response

• If you see a patient collapse or find a patient apparently unconscious, assess if they are responsive (shake and shout). Gently shake shoulders and ask loudly “are you all right?”

• If other members of staff are nearby it will be possible to undertake several actions simultaneously

3. If the Patient Responds

• Urgent medical assessment is required. Call for help according to local protocols. This means dialling 999 and asking for an emergency ambulance

• The patient may need to be placed in the recovery position to maintain their airway

4. If the Patient Does Not Respond

• Shout for help (if not done already)

• Turn the patient on to their back

• Open the airway using head tilt and lift chin

• If there is a risk of cervical spine injury, establish a clear upper airway by using jaw thrust or chin lift in combination with manual in-line stabilisation (MILS) of the head and neck by an assistant (if enough people are available).

If life threatening airway obstruction persists despite effective application of jaw thrust or chin lift, add head tilt a small amount at a time until the airway is open; establishing a patent airway, oxygenation and ventilation takes priority over concerns about a potential cervical spine injury

• Keeping the airway open, look, listen and feel to determine if the patient is breathing normally. This is a rapid check and should take less thanten seconds:

▪ Look for chest movement (breathing or coughing)

▪ Look for any other movement or signs of life

▪ Listen at the patient’s mouth for breath sounds

▪ Feel for air on your cheek

▪ If trained and experienced in the assessment of sick patients, check for breathing and asses the carotid pulse at the same time. The assessment should take less than ten seconds whether you do a pulse check or not.

• Agonal breathing (occasional, irregular gasps) is common in the early stages of cardiac arrest and is a sign of cardiac arrest, this should not be mistaken for a sign of life. Agonal breathing and limb movement can also occur during chest

compressions as cerebral perfusion improves, but is not indicative of a return of spontaneous circulation (ROSC)

• Changes in skin colour (e.g. pallor, cyanosis) in isolation are not diagnostic of cardiac arrest

5. If there are signs of life or a pulse

• Urgent medical assessment is required. Depending on the local protocols, this means contacting the Emergency Services by dialling 999

• Whilst awaiting the Emergency Team, assess and treat the patient using the ABCDE approach

• Follow the steps in 3 above whilst waiting for the team

• The patient is at high risk of further deterioration and cardiac arrest. Continued observation are required until help arrives

6. If there are No Signs of Life and No Pulse

• Start CPR and get a colleague to call the Emergency Services by dialling 999. Collect resuscitation equipment and a defibrillator (if available)

• If alone, leave the patient to get help and equipment

• Chest compressions in a patient whose heart is still beating are unlikely to cause harm. However, delays in diagnosing cardiac arrest and starting CPR will adversely affect changes of survival and must be avoided. If there is any doubt process as if there are no signs of life and no pulse

• Give thirty chest compressions following by two ventilations

• The correct hand position for chest compression is the middle of the lower half of the sternum

• This hand position can be found quickly if you have been taught to ‘place the heel of one hand in the centre of the chest with the other hand on top’ and your teaching included a demonstration of placing hand in the middle of the lower half of the sternum

• Ensure high quality chest compressions:

▪ Depth of 5-6cm

▪ Rate of 100-120 compressions per minute

▪ Allow the chest to recoil completely after each compression and relaxation

▪ Minimise any interruptions to chest compression (hand-off time)

• If available, use a prompt and/or feedback device to help ensure high quality chest compressions. The use of these devices should be part of a hospital wide quality improvement program that includes formal debriefing

• Do not rely on palpating carotid or femoral pulses to assess the effectiveness of chest compressions

• Resume compressions without any delay; place your hands back on the centre of the patient’s chest

• If there are enough team members, the person doing chest compressions should change around every two minutes or sooner if they are unable to maintain high quality chest compressions. This change should be done with minimal interruption to compressions. This should be done during planned pauses in chest compression such as during rhythm assessment

• Use whatever self-inflating bag and mask for airway and ventilation that is available. Use an inspiratory time of around one second and give enough volume to produce a visible rise of the chest wall. Avoid rapid or forceful breaths

• Add supplemental oxygen as soon as possible

• There are usually good clinical reasons to avoid mouth to mouth ventilation in clinical settings, and it is therefore not commonly used, but there will be situations where giving mouth to mouth breaths could be lifesaving (e.g. in nonclinical settings). If there are clinical reasons to avoid mouth to mouth contact, or you are unable to do this, do chest compressions until help or airway equipment arrives. A pocket mask or bag mask should be immediately available in all clinical areas

• As soon as an automated defibrillator arrives, apply the self-adhesive pads to the patient’s chest whilst chest compressions are ongoing. The use of adhesive electrode pads will enable rapid assessment of heart rhythm compared with the use of Echocardiogram (ECG) electrodes

• Once the pads are applied, pause briefly for a rapid rhythm check. Aim for a pause in chest compressions of less than five seconds

• Do not delay restarting chest compressions to check the cardiac rhythm

• If the automated defibrillator indicates that the patient requires a shock this should be carried out without delay

• Recommence chest compressions as soon as possible following the discharge of the shock

• Identify one person to be responsible for handover to the Ambulance Team. Use a structured communication tool for handover (e.g. Situation, Background, Assessment, and Recommendation (SBAR))

• Locate the patient’s record (if accessible) and ensure that they are available immediately when the Ambulance Team arrives

7. If the Patient is Not Breathing and has a Pulse (Respiratory Arrest)

• Ventilate the patient’s lungs (as described above) and check for a pulse every ten breaths (about every minute)

• This diagnosis can be made only if you are confident in assessing breathing and pulse or the patient has other signs of life (e.g. warm and well-perfused, normal capillary refill)

• If there are any doubts about the presence of a pulse, start chest compressions and continue ventilations until more experienced help arrives. All patients in respiratory arrest will develop cardiac arrest if the respiratory arrest is not treated rapidly and effectively

9. Hospital Cardiac Arrests

The exact sequence of actions after hospital cardiac arrest depends on several factors including:

• Location (clinical or non-clinical area; monitored or unmonitored patients)

• Skills of staff who respond

• Numbers of responders

• Equipment available

• Hospital system for response to cardiac arrest and medical emergencies.

Skills of staff who respond

All healthcare professionals should be able to recognise cardiac arrest, call for help and start resuscitation. Staff should do what they have been trained to do. Hospital staff who attend a cardiac arrest may have different competencies in managing the airway, breathing and circulation. Rescuers should use those resuscitation skills in which they have been trained (BLS, ILS, AILS).

Number of Responders

The single responder must ensure that help is on its way. If other staff are nearby, several actions can be undertaken simultaneously. Numbers of hospital staff tend to be fewer during the night and at weekends. This may influence patient monitoring, recognition, treatment and outcomes. Data from the US shows that survival rates from in-hospital cardiac arrest are lower during nights and weekends. Several studies show that increased nurse staffing is associated with lower rates of failure-to-rescue, and reductions in incidence of cardiac arrest, pneumonia, shock and death.

Equipment Available

The equipment used for CPR (including defibrillators) and the layout of equipment should be standardised throughout the hospital. A review by the Resuscitation Council (UK) of serious patient safety incidents associated with CPR and patient deterioration reported to the National Patient Safety Agency showed that equipment problems are a common contributing cause. All resuscitation equipment must be checked regularly to ensure it is ready for use. Appendix 1.

10.Diagnosis of Cardio-Pulmonary Arrest

Trained healthcare staff cannot assess the breathing and pulse sufficiently reliably to confirm cardiac arrest. Agonal breathing (infrequent and irregular gasps) is a pre-terminal event and common in the early stages of cardiac arrest. It should not be confused as a

sign of life/circulation. Agonal breathing can also occur during chest compressions as cerebral perfusion improves, but is not indicative of a Return of circulation. In addition, immediately after cardiac arrest the sudden cessation of cerebral blood flow can cause an initial short seizure-like episode that can be confused with epilepsy.

Delivering chest compressions to a patient with a beating heart is unlikely to cause harm. However, delays in diagnosis of cardiac arrest and starting CPR will adversely affect survival and must be avoided.

Rates of survival and complete physiological recovery following in-hospital cardiac arrest are poor in all age groups. For example, fewer than 20% of adult patients having an inhospital cardiac arrest (IHCA) will survive to go home. Cardiac arrest is rare in both pregnant women and children, but outcomes in these groups after in-hospital arrest are also poor. Prevention of in-hospital cardiac arrest requires staff education, monitoring of patients, recognition of patient deterioration, a system to call for help and an effective response.

Most adult survivors of in-hospital cardiac arrest have a witnessed and monitored ventricular fibrillation (VF) arrest and are defibrillated immediately. The underlying cause of arrest in this group is usually myocardial ischemia.

In comparison, cardiac arrest in patients in unmonitored ward areas is usually a predictable event not caused by heart disease. In this group, cardiac arrest often follows a period of slow and progressive physiological deterioration involving unrecognised or inadequately treated hypoxemia and hypotension. The cardiac arrest rhythm is usually asystole or Pulseless Electrical Activity (PEA) and the chances of survival to hospital discharge are extremely poor unless a reversible cause is identified and treated immediately

Regular monitoring and early, effective treatment of seriously ill patients appear to improve clinical outcomes and prevent some cardiac arrests

High Quality CPR

The quality of chest compressions during in-hospital CPR is frequently sub-optimal and interruptions are often prolonged. Even short interruptions to chest compressions can adversely impact on outcome and every effort must be made to ensure that continuous, effective chest compression is maintained throughout the resuscitation attempt. Chest compressions should commence at the beginning of a resuscitation attempt and continue uninterrupted apart from a brief pause for a specific intervention (e.g. rhythm check). Most interventions can be performed without interruptions to chest compressions. The team leader should monitor the quality of CPR, change the person providing chest compressions every 2 minutes (during rhythm assessment) or sooner if the quality of CPR is poor.

The Resuscitation Council (UK) advises that ‘Electrical defibrillation is well established as the only effective therapy for cardiac arrest due to ventricular fibrillation (VF) or pulse less

ventricular tachycardia (VT). The Scientific evidence to support early defibrillation is overwhelming, the single most important determinant of survival being the delay from collapse to delivery of the first shock. The chances of successful defibrillation decline at a rate of 7-10% with each minute; BLS will help to sustain a shockable rhythm but is not a definitive treatment’.

Where AEDs are in use they will indicate when a patient requires defibrillation. All members of staff in that department must receive annual training in line with the Mandatory training matrix and feel competent and confident in using the AED, See appendix 2, for defibrillator location sign which must be displayed where any AED is located. The administration of a defibrillator shock should not be delayed whilst waiting for more highly trained personnel to arrive.

The AED must be of a type recommended by Provide (if used on Provide sites) and must be used in accordance with the manufacturer’s recommendations. A named person will be responsible for the daily monitoring and maintenance according to the manufacturer’s recommendations.

Signposting to emergency equipment including AED devices must be clearly displayed in clinical areas to ensure that there is no delay in locating equipment.

Appendix 2

11.Paediatric Resuscitation

CPR is uncommon in infants and children. The basic difference between resuscitation of a child compared to an adult is that most children have a healthy heart, so the guidance advises that cardiac arrest occurs following respiratory arrest.

For nurses and other clinicians who work alone where resuscitation of a child is an unusual event, it is sufficient to teach these groups to use the adult sequence with the paediatric modifiers.

Age Definitions

• A new born is a child just after birth

• A neonate is a child in the first twenty-eight days of life

• An infant is a child under the age of one year

A child is between one year and puberty

Infant & Child BLS Sequence

Rescuers who have been taught adult BLS, and have no specific knowledge of paediatric resuscitation, should use the adult sequence. The following modifications to the adult sequence will make it more suitable for use in children:

• Give five initial rescue breaths before starting chest compressions.

• If you are on your own, perform CPR for one minute before going for help.

• Compress the chest by at least one third of its depth, approximately 4cm for an infant and approximately 5cm for an older child. Use two fingers for an infant; use

one or two hands for a child aged over one year, to achieve an adequate depth of compression.

The compression rate should be 100-120 per minute.

Those with a duty to respond to paediatric emergencies (usually Healthcare Professional Teams) should use the following sequence:

1. Ensure the Safety of the Rescuer and Child

2. Check the child’s responsiveness

• Gently stimulate the child and ask loudly ‘Are you all right?’

3. If the child responds by answering or moving

• Leave the child in the position in which you find them (provided they are not in further danger).

• Check their condition and get help if needed.

• Reassess them regularly.

4. If the child does not respond

• Shout for help

• Turn the child onto their back and open the airway using head tilt and chin lift:

• Place your hand on their forehead and gently tilt the head back.

• With your fingertip(s) under the point of the child’s chin, lift the chin.

• Do not push on the soft tissues under the chin as this may block the airway.

• If you still have difficulty opening the airway, try the jaw thrust method: place the first two fingers of each hand behind each side of the child’s mandible (jaw bone) and push the jaw forward.

• Children have a low threshold for suspected injury to the neck. If you suspect this, try to open the airway using jaw thrust alone. If this is unsuccessful, add head tilt gradually until the airway is open. Establishing an open airway takes priority over concerns about the cervical spine.

5. Keeping the airway open, look, listen and feel for normal breathing by putting your face close to the child’s face and looking along the chest

• Look for chest movements

• Listen at the child’s nose and mouth for breath sounds

• Feel for air movement on your cheek.

In the last few minutes before cardiac arrest a child may be taking infrequent, noisy gasps. Do not confuse this with normal breathing. Look, listen and feel for no more than ten seconds before deciding. If there are any doubts whether breathing is normal, act as if it is not.

6. If the child is breathing normally

• Turn the child on to their side into the recovery position

• Send or go for help and call for help dialling 999. Only leave the child if no other way of obtaining help is possible.

• Check for continued normal breathing.

7. If the Breathing is not normal or is absent

• Carefully remove any obvious airway obstruction.

• Give five initial rescue breaths.

• Although rescue breaths are described here, it is common in healthcare environments to have access to bag mask devices. Providers trained in their use should use them as soon as they are available.

• Whilst performing the rescue breaths, note any gag or cough response to your action. These responses, or their absence, will form part of your assessment of ‘signs of life’ described below.

8. Rescue breaths for an infant

• Ensure a neutral position of the head (as an infant’s head is usually flexed when supine, this may require some extension) and apply chin lift.

• Take a breath and cover the mouth and nasal apertures of the infant with your mouth, making sure you have a good seal. If the nose and mouth cannot both be covered in the older infant, the rescuer may attempt to seal only the infant’s nose or mouth with their mouth (if the nose is used, close the lips to prevent air escape).

• Blow steadily into the infant’s mouth and nose over one second, sufficient to make the chest rise visibly. This is the same time period as in adult practice.

• Maintain head position and chin lift, take your mouth away and watch for their chest to fall as air comes out.

• Take another breath and repeat this sequence four more times.

9. Rescue breaths for a child aged over one year

• Ensure head tilt and chin lift.

• Pinch the soft part of the nose closed with the index finger and put thumb of your hand on the child’s forehead.

• Open the child’s mouth a little, but maintain the chin lift.

• Take a breath and place lips around the child’s mouth, making sure that you have a good seal.

• Blow steadily into the child’s mouth over one second, sufficient to make the chest rise visibly.

• Maintaining head tilt and chin lift, take your mouth away and watch for the child’s chest to fall as air comes out.

• Take another breath and repeat this sequence four more times. Identify effectiveness by seeing that the child’s chest has risen and fallen in a similar fashion to the movement produced by a normal breath.

10. For both infants and children, if you have difficulty achieving an effective breath, the airway may be obstructed

• Open the child’s mouth and remove any visible obstruction. Do not perform blind finger sweep.

• Ensure that there is adequate head tilt and chin lift but also that the neck is not over extended.

• If head tilt and chin lift has not opened the airway, try the jaw thrust method.

• Make up to five attempts to achieve effective breaths. If still unsuccessful, move on to chest compression.

11. Assess the circulation (signs of life)

Take no more than ten seconds to

• Look for signs of life. These include any movement, coughing or normal breathing (not abnormal gasps or infrequent, irregular breaths).

12. If confident that you can detect signs of a circulation within ten seconds

• Continue rescue breathing, if necessary, until the child starts breathing effectively on their own. Turn the child onto their side (into the recovery position) if they start breathing effectively but remain unconscious.

• Reassess the child frequently.

13. For all children, compress the lower half of the sternum

• To avoid compressing the upper abdomen, locate the xiphisternum by finding the angle where the lowest ribs join in the middle. Compress the sternum one finger’s breadth above this.

• Compression should be sufficient to depress the sternum by at least one third of the depth of the chest, which is approximately 4cm for an infant and 5cm for a child.

• Release the pressure completely, then repeat at a rate of 100-120 per minute.

• Allow the chest to return to its resting position before starting the next compression.

• After fifteen compressions, tilt the head, lift the chin and give two effective breaths.

• Continue compressions and breaths in a ratio of 15:2.

The best method for compression varies slightly between infants and children.

14. Chest compression in Infants

• The lone rescuer should compress the sternum with the tips of two fingers.

• If there are two or more rescuers, use the encircling technique: -

▪ Place both thumbs flat, side by side, on the lower half of the sternum (as above), with the tips pointing towards the infant’s head

▪ Spread the rest of both hands, with the fingers together, to encircle the lower part of the infant’s rib cage with the tips of the fingers supporting the infant’s back

▪ Press down on the lower sternum with your two thumbs to depress it at least one third of the depth of the infant’s chest, approximately 4cm

15. Chest compression in a child aged over one year

• Place the heel of one hand over the lower half of the sternum (as above).

• Lift the fingers to ensure that pressure is not applied over the child’s ribs.

• Position yourself vertically above the child’s chest and, with your arm straight, compress the sternum to depress it by at least one third of the depth of the chest, approximately 5cm.

• In larger children, or for small rescuers, this may be achieved most easily by using both hands with the fingers interlocked.

16. Continue Resuscitation Until

• The child shows signs of life (normal breathing, cough or movement).

• Further qualified help arrives.

• You become exhausted

Use of Automated External Defibrillators in Children

Since the publication of Guidelines 2010 there have been continuing reports of safe and successful use of AEDs in children less than eight years, demonstrating that AEDs are capable of identifying arrhythmias accurately in children and are extremely unlikely to advise a shock inappropriately. Nevertheless, if there is any possibility that an AED may need to be used for children, the purchaser should check that the performance of the particular model has been tested in paediatric arrhythmias.

Many manufacturers now supply purpose-made paediatric pads or programs, which typically attenuate the output of the machine to 50–75 J. These devices are recommended for children between one and eight years. If no such system or manually adjustable machine is available, an unmodified adult AED may be used.

The Choking Child

Recognition of Choking

Back blows, chest thrusts and abdominal thrusts all increase intra-thoracic pressure and can expel foreign bodies from the airway. In half of the episodes documented with airway obstruction, more than one technique was needed to relieve the obstruction. There is no data to indicate which technique should be used first or in which order they should be applied. If one is unsuccessful, try the others in rotation until the object is cleared.

When a foreign body enters the airway, the child reacts immediately by coughing in an attempt to expel it. A spontaneous cough is likely to be more effective and safer than any manoeuvre a rescuer might perform. However, if coughing is absent or ineffective, and the object completely obstructs the airway, the child will become asphyxiated rapidly. Active interventions to relieve choking are therefore required only when coughing becomes ineffective, but they then must be commenced rapidly and confidently.

The majority of choking events in children occur during play or whilst eating, when a carer is usually present. Events are therefore frequently witnessed, and interventions are usually initiated when the child is conscious.

Choking is characterised by the sudden onset of respiratory distress associated with coughing, gagging, or stridor. Similar signs and symptoms may also be associated with other causes of airway obstruction, such as laryngitis or epiglottitis, which require different management. Suspect choking caused by a foreign body if:

• The onset was very sudden

• There are no other signs of illness

• There are clues to alert the rescuer (e.g. a history of eating or playing with small items immediately prior to the onset of symptoms)

General signs of choking

• Witnessed episode

• Coughing or choking

• Sudden onset

• Recent history of playing with or eating small objects

Ineffective coughing

• Unable to vocalise

• Quiet or silent cough

• Unable to breathe

• Cyanosis

• Decreasing level of consciousness

Effective cough

• Crying or verbal response to questions

• Loud cough

• Able to take a breath before coughing

• Fully responsive

Paediatric Choking Algorithm

Relief of Choking

Consider the safest action to manage the choking child:

• If the child is coughing effectively, then no external manoeuvre is necessary. Encourage the child to cough and monitor continuously.

• If the child’s coughing is, or is becoming, ineffective shout for help immediately and determine the child’s conscious level.

Conscious Child with Choking

• If the child is still conscious but has absent or ineffective coughing, give back blows.

• If back blows do not relieve choking, give chest thrusts to infants or abdominal thrusts to children. These manoeuvres create an ‘artificial cough’ to increase intrathoracic pressure and dislodge the foreign body.

Back Blows

In an Infant

• Support the infant in a head downwards, prone position, to enable gravity to assist removal of the foreign body.

• A seated or kneeling rescuer should be able to support the infant safely across their lap.

• Support the infant’s head by placed the thumb of one hand at the angle of the lower jaw and one or two fingers from the same hand at the same point on the other side of the jaw.

• Do not compress the soft tissues under the infant’s jaw, as this will exacerbate the airway obstruction.

• Deliver up to five sharp blows with the heel of one hand in the middle of the back between the shoulder blades.

• The aim is to relieve the obstruction with each blow rather than give all five blows.

In a Child over the age of one year

• Back blows are more effective if the child is positioned head down

• A small child may be placed across the rescuer’s lap as with an infant

• If this is not possible, support the child in a forward learning position and deliver the back blows from behind.

If back blows fail to dislodge the object, and the child is still conscious, use chest thrusts for infants or abdominal thrusts for children. Do not use abdominal thrusts for infants.

Chest Thrusts for Infants

• Turn the infant into a head downwards supine position. This is achieved safely by placing your free arm along the infant’s back and encircling the occiput with your hand

• Support the infant down your arm, which is placed down (or across) your thigh

• Identify the landmark for chest compression (lower sternum approximately a finger’s breadth above the xiphisternum)

• Deliver up to five chest thrusts. These are similar to chest compressions, but sharper in nature and delivered at a slower rate

• The aim is to relive the obstruction with each thrust rather than give all five thrusts.

Abdominal Thrusts for Children aged over one year

• Stand or kneel behind the child. Place your arms under the child’s arms and encircle their torso

• Clench your fist and place it between the umbilicus and xiphisternum

• Grasp this hand with your other hand and pull sharply inwards and upwards

• Repeat up to four more times

• Ensure that pressure is not applied to the xiphoid process or the lower rib cage as this may cause abdominal trauma

• The aim is to relive the obstruction with each thrust rather than give all five thrusts

Following chest or abdominal thrusts: reassess the child

• If the object has not been expelled and the victim is still conscious, continue the sequence of back blows and chest (for infant) or abdominal (for children) thrusts

• Call out, or send for help if it is still not available

• Do not leave the child at this stage

If the object is expelled successfully, assess the child’s clinical condition. It is possible that part of the object may remain in the respiratory tract and cause complications. If there is any doubt, seek medical assistance.

Unconscious

child with choking

• If the choking child is, or becomes, unconscious, place them on a firm, flat surface

• Call out, or send, for help if it is still not available

• Do not leave the child at this stage

Airway opening

• Open the mouth and look for any obvious object

• If one is seen, try to remove it with a single finger sweep

• Do not attempt blind or repeated finger sweeps – these can push the object more deeply into the pharynx and cause injury

Rescue breaths

• Open the airway and attempt 5 rescue breaths

• Assess the effectiveness of each breath; if a breath does not make the chest rise, reposition the head before making the next attempt

Chest compression and CPR

• Attempt 5 rescue breaths and if there is no response, proceed immediately to chest compressions regardless of whether the breaths are successful

• Follow the sequence for single rescuer CPR for approximately 1 minute before summoning an ambulance (if this has not already been done by someone else)

• When the airway is opened for attempted delivery of rescue breaths, look to see if the foreign body can be seen in the mouth

• If an object is seen, attempt to remove it with a single finger sweep

• If it appears that the obstruction has been relieved, open and check the airway as above. Deliver rescue breaths if the child is not breathing and then assess for signs of life. If there are none, commence chest compressions and perform CPR

• If the child regains consciousness and is breathing effectively, place them in a safe side-lying (recovery) position and monitor breathing and consciousness level whilst awaiting the arrival of the ambulance

Advanced Direction

An Advance Directive, also known as a ‘Living Will’ enables a competent person to state in advance what their wishes are for future medical treatment. Resuscitation must not be attempted if CPR is contrary to the recorded, sustained wishes of an adult who was mentally competent and aware of the implications at the time of making that advance decision. Health professionals are bound to comply when the refusal specifically addresses the situation that has arisen. It is not necessary for refusal to be in writing in order to be valid. People often discuss their wishes with a General Practitioner or another health professional who must record the discussion in the patient’s notes.

During the transfer of patients by the ambulance service, the Do Not Attempt Resuscitation (DNAR) policy held by the ambulance service will come into effect. The policy states that ambulance staff transferring patients between hospitals or discharge from hospitals to another place of care must comply with a ‘Do Not Attempt Resuscitation’ order given to them.

See CPOL37 East of England Do Not Attempt Resuscitation Policy for guidance on decision making for competent, non-competent adults and children, and young adults.

12.Equipment

This policy sets out the equipment required for CPR on Provide hospital wards, Assessment and Rehabilitation Unit (ARU), St. Peter’s Outpatients (adults only).

Community settings and other clinics should be managed through BLS and the 999 operator may direct rescuers to the nearest available AED device.

NB – Children’s clinics run at St Peter’s Outpatient Department are the responsibility of an alternative healthcare provider. The provision of emergency equipment for children attending these clinics is the responsibility of that provider.

A child visiting St Peter’s Outpatient Department who collapses should be supported using modified Basic Life Support for Adults, until emergency services arrive.

Community Hospitals - ADULT

AIRWAY AND BREATHING

Item

Pocket mask with oxygen port and oxygen tubing

Oxygen mask with reservoir

Self-inflating bag with reservoir

Clear face masks – sizes 3, 4 and 5

Oropharyngeal airways –sizes 2, 3 and 4

Portable suction (battery or manual) with Yankauer sucker and soft suction catheters

Oxygen cylinder (with key where necessary)

Stethoscope

Suggested Availability Comments

Immediate

Within grab bags

Wards and ARU and Out patients St Peters Adult only

For use with self-inflating bag

Within Grab bags

Airway suction equipment. Available wards Out patients St Peters, ARU.

Available on Hospital sites

Available with Grab bag

Community Hospitals - ADULT

CIRCULATION

Item

Automated external defibrillator (AED)

Adhesive defibrillator pads x 2 packs

ECG electrodes

Intravenous cannulae (selection of sizes) and 2% chlorhexidine/alcohol

Suggested Availability Comments

Immediate

Type of defibrillator and locations determined by local risk assessment

With AED

If monitoring devices are available

Will depend on local policy and staff training

wipes, tourniquets and cannula dressings

Adhesive tape

Intravenous infusion set

0.9% sodium chloride (1000ml)

Selection of needles and syringes

Dressing pads x 2

Immediate/ Accessible

Accessible

Available all areas

Will depend on local policy and staff training

Accessible Wards

Accessible

Will depend on local policy and staff training

Immediate Wards and RAU, St Peters Out patients

Community Hospitals - ADULT

OTHER ITEMS

Item

Clock/ timer

Gloves, aprons, eye protection

Sharps container and clinical waste bag

2% chlorhexidine/ alcohol wipes

Blood sample tubes

Blood glucose analyser with appropriate strips

Manual handling equipment

Cardiorespiratory arrest record forms for patient notes. Audit forms and DNACPR forms

Suggested Availability Comments

Accessible

Immediate

Further personal protective equipment may be required according to local policy

Immediate Sharps container must be immediately available wherever sharps are used

Accessible

Usually in clinical room, must not delay transfer

According to local policy

According to setting. See ‘Guidance for safer handling during resuscitation in healthcare settings’

Accessible

Community Hospitals - ADULT

CARDIAC ARREST DRUGS – FIRST LINE for intravenous use

Item Suggested Availability Comments

Adrenaline 1mg (=10ml

1:10,000) IV as a prefilled syringe x 3

Amiodarone 300mg as a prefilled syringe x 1

Immediate

Accessible

Number of syringes depends on access to further syringes. 1 syringe needed for each 4.5 minutes of CPR. Will depend on local policy and staff training

First dose required after 3 defibrillation attempts. Will depend on local policy and staff training

Staff carrying out clinical procedures away from the health care setting, such as patient homes, are not normally expected to carry resuscitation equipment.

Where specific equipment is required for higher risk procedures such as immunisations, it is expected that staff will not carry out a high-risk procedure without the appropriate equipment available e.g. adrenaline (as per CPOL35 Anaphylaxis Policy V5).

Each area should have a nominated person(s) responsible for checking the state of readiness of all resuscitation equipment and drugs, e.g. the expiry date and availability, on a regular basis. This will be weekly in clinics and OPD departments, and after every event when the equipment is used. For wards and high-risk areas such as endoscopy and minor ops, there will be daily checking of AEDs and open areas of resus trolley, and weekly checking of locked/sealed areas of resus trolley. Checks should be recorded, dated and signed against the checklist, and retained for future audit. Any discrepancies, missing, broken or expired equipment, should be replaced immediately without delay and actions documented.

Equipment checks should include the following:

• Testing and electrical safety stickers are within date

• Suction equipment performs to its specification. If battery powered, check charging light is on and functional. Check when disconnected from charger. Check strength of suction. Ensure tubing and sucker are attached and ready for operation in an emergency

• Oxygen cylinders contain sufficient gas. Check oxygen is present at flow meter outlet when turned on. Check for leaks

• For solely battery powered AEDs ensure additional battery is present

• Functioning indicator on AEDs must be checked as well as the expiry date of the defibrillation electrodes; the device should be charged and discharged to check functionality. Also check compatibility of connections and ensure spare pads are available

The checking of equipment must be recorded, dated and signed in a specific book, by a designated person – daily on the community wards and in high risk areas, minor ops and endoscopy, and weekly in other clinical areas.

To avoid potential error with defibrillator pad incompatibility, ensure all AEDs have model type and model number clearly displayed in bold print along with information about which pads should be used with that model. Some model numbers are very small and if not noted, the wrong pads may be ordered inadvertently.

13.Duty of Care and Standard of Care

Duty of Care

In the United Kingdom, there is generally no legal obligation on an individual to assist a person in need of resuscitation, provided they were not the cause of the casualty requiring treatment. In other words, there is generally no legal liability for a mere omission of act. This is different from the situation in many European countries, where the law does, in certain circumstances, impose a duty to help others. However, it should be noted that health care professionals have a professional obligation to administer BLS.

The Standard of Care

Members of health care professions who attempt resuscitation are expected to employ the highest professional standard of care compatible with their position and/or speciality in the health service, and their level of training. For example, both doctors and non-clinical staff might be obliged to provide some assistance to a collapsed patient; the level of care and expertise employed by medical staff would be expected to be of a different order.

Relatives being present during resuscitation

This policy follows guidance from the Resuscitation Council (UK) which states:

‘The presence of relatives during a resuscitation attempt is a controversial issue. There have been increasing requests by relatives to be present at resuscitation of their loved one. This statement and the guidelines do not supply all the answers, but attempt to enable a balanced decision to be made’.

Unfortunately, within the pre-hospital environment, this is occasionally unavoidable. Staff need to be mindful of theneeds of the patient as apriority, but also to consider any relatives that may be present.

The Resuscitation Council recommends that:

• Acknowledge the difficulty of the situation

• Ensure that the relative understands that they have a choice of whether or not to be present during resuscitation

• Avoid provoking feelings of guilt, whatever the decision

• Explain that they will be accompanied by someone specifically to care for them, whether or not they enter the resuscitation room. Make sure introductions are made and names known

• Give a clear and honest explanation of what has happened in terms of the illness or injury, and warn them of what they can expect to see when they enter the room, particularly the procedures they may witness

• Ensure they understand that they will be able to leave and return at any time, and will always be accompanied

• Ask the relative not to interfere for the good of the patient and their own safety. They will be allowed the opportunity to touch the patient when it is safe to do so.

• Explain the procedures as they occur in terms that the relative can understand. Ultimately this may mean being able to explain that the patient has failed to respond and has died, and that resuscitation is to be abandoned

• Advise that once the relative has died there may be a brief interval while equipment is removed, after which they can return to be with the deceased in private. Under some circumstances, the Coroner may require certain tubes to be left in place

• Offer the relatives time to think about what has happened and give them the opportunity to ask further questions

Stopping Resuscitation

If a relative objects to the resuscitation attempt being abandoned, it should be continued while the team leader reviews the situation, involving those participating and explaining the reasons for their decision to the relative. Alternatively, a relative may voice objections to the continued resuscitation and the team leader must decide in a similar manner.

The final decision to stop resuscitation must always be made by the team leader.

It is important to realise that despite the expressed opinions, the relative may later have guilt feelings if they feel that the decision was theirs. Finally, all the staff involved must be given the opportunity to debrief after resuscitation, particularly when relatives have been present. All abandoned resuscitation attempts must be identified within the Datix form.

Summary

• Offer the relatives the opportunity to be present during resuscitation

• Allocate a specific person to be with them at all times

• Relatives must understand that if they interfere they may be asked to leave

• Explain what is happening in terms they can understand

• Allow them to make physical contact with the patient when it is safe to do so

14.References

Mental Capacity Act 2005 (England and Wales).

National Institute for Health and Clinical Excellence 2007 NICE Clinical Guideline 50. Acutely ill patients in hospital: recognition of and response to acute illness in adults in hospital. National Institute for Health and Clinical Excellence; London: Resuscitation Council (UK) 2015 Resuscitation Guidelines

Royal College of Physicians. July 2012 National Early Warning Score (NEWS). Standardising the assessment of acute-illness severity in the NHS. Report of a working Party.

The Royal College of Paediatric and Child Health. 2004 Withholding and Withdrawing Life Sustaining Treatment in Children: A Framework for Practice, 2nd edn. London: RCPCH

Guidance from the British Medical Association, the Resuscitation Council (UK), and the Royal College of Nursing. 2014

Recommended standards for recording decisions about cardiopulmonary resuscitation. Resuscitation Council (UK). Revised 2015

Appendix 1: Emergency Trolley Checklist/Grab Bag

Ward/Department: Month:

Please sign the CHECKED BY column at the end of each page to show you have carried out the check

Airway and Breathing

Pocket mask with oxygen port and tubing

Oxygen mask with reservoir

Self-inflating bag with reservoir

Clear face masks, sizes

3,4,5

Oropharyngeal airways

sizes2,3,4

Portable suction, battery or manual with yanker sucker and soft suction catheters

Oxygen cylinder and key as required

Stethoscope

defibrillator pads x 2 packs

ECG electrodes

Ward/Department: Month:

Please sign the CHECKED BY column at the end of each page to show you have carried out the check

Expiry date

Intravenous cannulae

(selection of sizes) and 2% chlorhexidine/alco hol wipes, tourniquets and cannula dressings

Adhesive tape

Intravenous infusion set

0.9% sodium chloride for infusion (1000 ml)

Selection of needles and syringes

Dressing pads

Other Items

Clock or timer

Glovers apron eye protection

Sharps container and clinical waste bag

2% chlorhexidine wipes

Blood glucose analyser with strips Manual handling equipment

CHECKED BY:

Appendix 2: Automated Defibrillator Sign for use in Provide CIC

EQUALITY IMPACT ASSESSMENT TEMPLATE: Stage 1: ‘Screening’

Name of project/policy/strategy (hereafter referred to as “initiative”):

CPOL15 Policy and Procedure for Cardiopulmonary Resuscitation (CPR)

Provide a brief summary (bullet points) of the aims of the initiative and main activities:

The application of the policy is primarily for clinical staff

To outline the expectations, obligations and duty of care of Provide employees in providing CardioPulmonary Resuscitation procedures to patients.

Project/Policy Manager: Head of Quality and Safety

Date: October 2019

This stage establishes whether a proposed initiative will have an impact from an equality perspective on any particular group of people or community – i.e. on the grounds of race (incl. religion/faith), gender (incl. sexual orientation), age, disability, or whether it is “equality neutral” (i.e. have no effect either positive or negative). In the case of gender, consider whether men and women are affected differently.

Q1. Who will benefit from this initiative? Is there likely to be a positive impact on specific groups/communities (whether or not they are the intended beneficiaries), and if so, how? Or is it clear at this stage that it will be equality “neutral”? i.e. will have no particular effect on any group.

Q2. Is there likely to be an adverse impact on one or more minority/under-represented or community groups as a result of this initiative? If so, who may be affected and why? Or is it clear at this stage that it will be equality “neutral”?

Q3. Is the impact of the initiative – whether positive or negative - significant enough to warrant a more detailed assessment (Stage 2 – see guidance)? If not, will there be monitoring and review to assess the impact over a period time? Briefly (bullet points) give reasons for your answer and any steps you are taking to address particular issues, including any consultation with staff or external groups/agencies.

Guidelines: Things to consider

• Equality impact assessments at Provide take account of relevant equality legislation and include age, (i.e. young and old,); race and ethnicity, gender, disability, religion and faith, and sexual orientation.

• The initiative may have a positive, negative or neutral impact, i.e. have no particular effect on the group/community.

• Where a negative (i.e. adverse) impact is identified, it may be appropriate to make a more detailed EIA (see Stage 2), or, as important, take early action to redress this –e.g. by abandoning or modifying the initiative. NB: If the initiative contravenes equality legislation, it must be abandoned or modified.

• Where an initiative has a positive impact on groups/community relations, the EIA should make this explicit, to enable the outcomes to be monitored over its lifespan.

• Where there is a positive impact on particular groups does this mean there could be an adverse impact on others, and if so can this be justified? - e.g. are there other existing or planned initiatives which redress this?

• It may not be possible to provide detailed answers to some of these questions at the start of the initiative. The EIA may identify a lack of relevant data, and that datagathering is a specific action required to inform the initiative as it develops, and also to form part of a continuing evaluation and review process.

• It is envisaged that it will be relatively rare for full impact assessments to be carried out at Provide. Usually, where there are particular problems identified in the screening stage, it is envisaged that the approach will be amended at this stage, and/or setting up a monitoring/evaluation system to review a policy’s impact over time.

EQUALITY IMPACT ASSESSMENT TEMPLATE: Stage 2:

(To be used where the ‘screening phase has identified a substantial problem/concern)

This stage examines the initiative in more detail in order to obtain further information where required about its potential adverse or positive impact from an equality perspective. It will help inform whether any action needs to be taken and may form part of a continuing assessment framework as the initiative develops.

Q1. What data/information is there on the target beneficiary groups/communities? Are any of these groups under- or over-represented? Do they have access to the same resources? What are your sources of data and are there any gaps?

Q2. Is there a potential for this initiative to have a positive impact, such as tackling discrimination, promoting equality of opportunity and good community relations? If yes, how? Which are the main groups it will have an impact on?

Q3. Will the initiative have an adverse impact on any particular group or community/community relations? If yes, in what way? Will the impact be different for different groups – e.g. men and women?

Q4. Has there been consultation/is consultation planned with stakeholders/ beneficiaries/ staff who will be affected by the initiative? Summarise (bullet points) any important issues arising from the consultation.

Q5. Given your answers to the previous questions, how will your plans be revised to reduce/eliminate negative impact or enhance positive impact? Are there specific factors which need to be taken into account?

Q6. How will the initiative continue to be monitored and evaluated, including its impact on particular groups/ improving community relations? Where appropriate, identify any additional data that will be required.

Guidelines: Things to consider

• An initiative may have a positive impact on some sectors of the community but leave others excluded or feeling they are excluded. Consideration should be given to how this can be tackled or minimised.

• It is important to ensure that relevant groups/communities are identified who should be consulted. This may require taking positive action to engage with those groups who are traditionally less likely to respond to consultations, and could form a specific part of the initiative.

• The consultation process should form a meaningful part of the initiative as it develops, and help inform any future action.

• If the EIA shows an adverse impact, is this because it contravenes any equality legislation? If so, the initiative must be modified or abandoned. There may be another way to meet the objective(s) of the initiative.

Further information:

Useful Websites www.equalityhumanrights.com Website for new Equality agency www.employers-forum.co.uk – Employers forum on disability www.disabilitynow.org.uk – online disability related newspaper www.efa.org.uk – Employers forum on age