Compliance in resuscitation & medical emergencies for Primary Care

General Practices are expected to comply with quality standards relating to training, equipment and drugs for resuscitation and managing medical emergencies. The information below should help practices comply and ensure they are meeting all their requirements.

The Resuscitation Council (UK)

Training of staff

The Resuscitation Council UK issued quality standards for general practices in November 2013 that sets out the minimum standards expected for training and equipment for providers of primary care.

The Standards for the training of both clinical and non-clinical staff states:

1. All staff in a primary care organisation, including non-clinical staff, should undergo regular training in resuscitation of both adults and children to the level appropriate to their role.
2. Staff should undergo such training at induction and at appropriately frequent, regular intervals thereafter to maintain knowledge and skills.
3. According to Resuscitation Council (UK) guidelines, training must be in place to ensure that clinical staff can undertake cardiopulmonary resuscitation (CPR). Training and facilities must ensure that, when cardiorespiratory arrest occurs, as a minimum all clinical staff can:
   
   • recognise cardiorespiratory arrest;
   • summon help;
   • start CPR;
   • attempt defibrillation (if appropriate) with an automated external defibrillator (AED) with the minimum of delay, whenever possible within 3 minutes of collapse.
4. Clinical staff should have at least annual updates.
5. Training and updates that include an assessment are recommended for clinical staff.
6. Non-clinical staff generally should have annual updates also. However, a local risk assessment may be undertaken to assess the likelihood of them encountering a patient requiring resuscitation (for example a driver for an out-of-hours doctor’s car may be required to assist at a cardiorespiratory arrest more frequently than a secretary in some daytime General Practices).
7. As a minimum, non-clinical staff must be trained to:
   
   • recognise cardiorespiratory arrest;
   • summon help;
   • start CPR using chest compressions.
8. For all staff, various methods to acquire, maintain and assess resuscitation skills and knowledge can be used for updates (e.g. life support courses, manikin/simulation training, mock-drills, ‘rolling refreshers’, e-learning, video-based training/self instruction). The choice should be determined locally. For example, training materials such as Lifesaver, developed by the Resuscitation Council (UK), or very brief videos aimed at lay people may be appropriate for non-clinical staff. Hands-on training using simulation and including assessment is recommended for clinical staff.
9. A system must be in place for identifying any resuscitation equipment that requires special training, and for ensuring that such training takes place.
10. The RO or resuscitation lead should organise and co-ordinate resuscitation training for staff. However, in order to achieve training targets, the RO may need to delegate some aspects of training.
11. All primary care providers should make provision for staff to have sufficient time to train in resuscitation skills as part of their employment.
12. Specific training for cardiorespiratory arrests in special circumstances (e.g. resuscitation of children or the newborn) should be provided for medical, nursing and other clinical staff where appropriate.
13. All training must be recorded (e.g. in an organisation’s training database).

The relevant professional bodies refer to these quality statements with regard to revalidation and the need to demonstrate evidence of CPR and AED training as part of annual statutory and mandatory training.

Equipment and drug lists

The RC(UK) also has a Suggested Minimum Equipment List which (appropriate to your staff’s level of skill and/or training) should include:

The Care Quality Commission (CQC)

The CQC has several elements of resuscitation practice, equipment and training that will be inspected. The CQC refers to the Resuscitation Council Standards documents linked to previously.

The links below help practices to meet these standards:

• Safe Care and Treatment
• CPR for GP Practices
• Defibrillators, oxygen & oximeters
• Emergency drugs in GP Practices

There should be evidence of documented procedures that ensure all emergency drugs and equipment with a limited shelf life are within their expiry date. It is suggested that this is done weekly.

Debriefing and evidence of reflective practice

Following any medical emergency or resuscitation attempt there should be documented evidence that the practice has debriefed and reflected on the incident. Any action points that emerge from the debrief should have evidence to show they have been addressed. This documentation should be available for CQC inspections as evidence of reflective practice informing improvements in care.

Defibrillators

All general practices are now expected to have an automated external defibrillator.

The Resuscitation Council have recommended that defibrillators with CPR performance feedback are a good option, particularly for environments that do not have to perform CPR regularly. Constant feedback on rate and depth during an arrest helps maintain high quality CPR, which has a huge impact on positive outcomes in resuscitation attempts.

Oxygen

Oxygen cylinders should be able to provide high flow rates of 15 litres/ minute and should be able to provide at least 30 minutes of emergency oxygen. Small portable cylinders contain around 340 – 450 litres of oxygen depending on the manufacturer and therefore should be kept full at all times. Multiple cylinders may be required to adequately cover the practice. If they are partially used they should be refilled immediately. Practices should make provision for when their cylinders are away being refilled.

It should be noted that these are minimum standards and are aimed at resuscitation. General practices will keep additional monitoring equipment with their emergency equipment that will assist them in making decisions about the severity of medical emergency such as ECG machine, pulse oximeters, sphygmomanometer and cuffs, pen torch, blood glucose monitors, large volume spacers, peak flow meters, nebuliser masks, thermometer, tourniquet, cannula. Note this is not an exhaustive list, other items may be included.

References & Further Reading

1. https://www.resus.org.uk/quality-standards/primary-care-quality-standards-for-cpr/
2. https://www.resus.org.uk/quality-standards/primary-care-equipment-and-drug-lists/#equipment

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