Quality standards for cardiopulmonary resuscitation practice and training

Acute care - equipment and drug lists

Contents

1. Introduction and scope   
2. General points  
3. Acute hospital care - ADULT 
  3.1 Airway and breathing
  3.2 Circulation
  3.3 Other items
  3.4 Cardiac arrest drugs - First-line for intravenous use  !
  3.5 Cardiac arrest and peri-arrest drugs for intravenous use  !
  3.6 Other drugs
  3.7 Notes
4. Acute hospital care - PAEDIATRIC
  4.1 Airway and breathing
  4.2 Circulation
  4.3 Other items
  4.4 Cardiac arrest drugs - First line for intravenous use  !
  4.5 Cardiac arrest and peri-arrest drugs for intravenous use  !
  4.6 Other emergency drugs
  4.7 Notes
    
Drug tables for cardiac arrest are highlighted in the text with the symbol ! 

1. Introduction and scope

Healthcare organisations have an obligation to provide a high-quality resuscitation service, and to ensure that staff are trained and updated regularly to a level of proficiency appropriate to each individual’s expected role.

As part of the quality standards for cardiopulmonary resuscitation practice and training this document provides lists of the minimum equipment and drugs required for cardiopulmonary resuscitation. These lists are categorised according to the clinical setting.

This document is referred to by the standards documents pertaining to specific clinical settings. Links to these documents are provided below:

     Acute care
     Primary care
     Primary dental care
     Mental health inpatient care
     Community hospitals care

The core standards for the provision of cardiopulmonary resuscitation across all healthcare settings are described in the document:

Introduction and overview to quality standards for cardiopulmonary practice and training

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2. General points

1. All clinical service providers must ensure that their staff have immediate access to appropriate resuscitation equipment and drugs to facilitate rapid resuscitation of the patient in cardiorespiratory arrest. The standard defibrillator sign should be used in order to reduce delay in locating a defibrillator in an emergency    www.resus.org.uk/defibrillators/standard-sign-for-aeds/
2. All settings must have a means of calling for help (e.g. landline telephone [internal or external], mobile telephone with reliable signal, or alarm bell).
3. Standardisation of the equipment used for cardiopulmonary resuscitation (including defibrillators and emergency suction equipment), and the layout of equipment and drugs throughout an organisation is recommended.
4. It is recognised that planning for every eventuality is complex; therefore, organisations must undertake a risk assessment to determine what resources are required given their local circumstances. Risk factors to consider include patient group (e.g. adults, children), incidence of cardiac arrest, training of staff, and access to expert help.
   
   a. For example, in secondary or tertiary care specific locations may need special provisions (e.g. for failed intubation, tracheostomy care, cardiac arrest in pregnancy etc).
   b. Some settings need a wide range of equipment immediately available (e.g. resuscitation room in emergency department). Suggested options include having basic equipment (and possibly drugs) available immediately (on a resuscitation trolley), and further equipment and drugs arriving with a resuscitation team (in a ‘grab-bag’), or in some settings as part of an ambulance response.
   c. Staff should be trained to use the available equipment according to their expected roles.
   
5. Depending on the organisation, this risk assessment must be overseen by a Resuscitation Committee or a designated resuscitation lead. Expert advice should also be sought locally from those commonly involved in resuscitation (e.g. resuscitation officers, emergency physicians, cardiac care unit staff, intensivists, anaesthetists, prehospital care physicians).
6. Resuscitation equipment should be single-patient-use and latex-free, whenever possible and appropriate. Where non-disposable equipment is used, a clear policy for decontamination after each use must be available and must be followed.
7. Personal protective equipment (e.g. gloves, aprons, eye protection) and sharps boxes must be available, based on a local risk assessment and local polices.
8. A reliable system of equipment checks and replacement must be in place to ensure that equipment and drugs are always available for use in a cardiac arrest. The frequency of checks should be determined locally.
9. It is recommended that equipment and drugs are presented in a clear and logical manner to enable easier use during an emergency.
10. The manufacturer’s instructions must be followed regarding use, storage, servicing and expiry of equipment and drugs.
11. Further equipment and drugs may be needed to manage other types of emergencies that are likely to be encountered in a particular setting; this may include:
    • monitoring equipment (e.g. blood pressure, pulse oximetry, 3-lead electrocardiogram [ECG], temperature, waveform capnography)
    • 12-lead ECG recorder
    • difficult airway equipment (e.g. scalpel and bougie for cricothyroidotomy)
      
    • near-patient tests (e.g. blood glucose, blood gas analysis).
12. A formal procurement process that includes trialing of equipment before purchase is recommended. Trialing of resuscitation equipment can take place in actual care settings or in simulated clinical scenarios.
13. The precise availability of equipment and drugs should be determined locally. The equipment lists include a suggestion on the immediacy with which equipment and drugs should be available:
    
    a. Immediate - available for use within the first minutes of cardiorespiratory arrest (i.e. at the start of resuscitation).
    b. Accessible - available for prompt use when the need is determined by resuscitation team.
    
14. These lists are not exhaustive. Local experts should be consulted to ensure that the appropriate equipment and drugs are available when they are needed, to enable provision of high-quality attempted resuscitation.

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Acute hospital care - Adult       

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NOTES: Acute Hospital Care - ADULT

1. Portable monitoring and other equipment for patient transfer should be readily available.
2. Further drugs for post-cardiac-arrest care (e.g. inotropes, vasopressors, anaesthetic agents, antibiotics) should be available readily, according to local critical care policies.
3. Keeping resuscitation drugs locked away - this problem was addressed in detail in 2005 by the Royal Pharmaceutical Society of Great Britain in a revision of the Duthie Report (1988) ‘The Safe and Secure Handling of Medicines’. The RC (UK) responded with a statement, along with an accompanying letter written to the CQC explaining the position. www.resus.org.uk/media/statements/keeping-resuscitation-drugs-locked-away/
   

Supporting information

1. Association of Anaesthetists of Great Britain and Ireland (AAGBI) Safety Guideline - Interhospital Transfer. 2009. http://www.aagbi.org
2. Intensive Care Society. Guidelines for the transport of the critically ill adult (3rd Edition 2011). http://www.ics.ac.uk
3. The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus https://www.diabetes.org.uk/Documents/About%20Us/Our%20views/Care%20recs/JBDS%20hypoglycaemia%20position%20(2013).pdf

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NOTES - Acute Hospital Care - PAEDIATRIC

1. The volume and/or quantities of the listed fluids and drugs stored and their location should be determined by local policy. This should ensure that there is sufficient availability to manage a paediatric resuscitation according to Resuscitation Council (UK) resuscitation guidelines without undue delay.
2. Portable monitoring and other equipment for patient transfer should be readily available.
3. Further drugs for post-cardiac-arrest care (e.g. inotropes, vasopressors, anaesthetic agents, antibiotics) should be readily available according to local critical care policies.
4. All interventions (e.g. drug therapy, practical procedures, discussions with other staff or relatives) should be documented with date and time and signed by an identifiable member of staff.
5. Keeping resuscitation drugs locked away - this problem was addressed in detail in 2005 by the Royal Pharmaceutical Society of Great Britain in a revision of the Duthie Report (1988) ‘The Safe and Secure Handling of Medicines’. The RC (UK) responded with a statement, along with an accompanying letter written to the CQC explaining the position. www.resus.org.uk/media/statements/keeping-resuscitation-drugs-locked-away/
   

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November 2013, updated May 2017, updated March 2018