Quality standards for cardiopulmonary resuscitation practice and training

Introduction and overview - Quality standards

Contents

    Contributors
1. Introduction and scope
2. Core standards
3. Methods
4. Implementation
5. Supporting Information
6. APPENDIX: Conflict of interest declaration

Contributors

The organisations listed above have all contributed to this Introduction and Overview document.   

The Resuscitation Council (UK) Patient Advisory Group has advised on this document. 
 

Working group members:

Jasmeet  Soar (Chair), Resuscitation Council (UK)
Mick Colquhoun, Resuscitation Council (UK)
Tracey Courtnell, Resuscitation Council (UK)
Peter-Marc Fortune, Paediatric Intensive Care Society
Jamie Fulton, Resuscitation Council (UK)
David Gabbott, Royal College of Anaesthetists
Matthew Griffiths, Royal College of Nursing
Susan Hampshire, Council for Professionals as Resuscitation Officers
Fiona Jewkes, Royal College of General Practitioners
K-L Kong, Resuscitation Council (UK)
Sarah Mitchell, Resuscitation Council (UK)
Ian Maconochie, Royal College of Paediatrics and Child Health
Jerry Nolan, Resuscitation Council (UK)
Gavin Perkins, Faculty of Intensive Care Medicine
David Pitcher, Royal College of Physicians, Resuscitation Council (UK)
Steven Searle, College of Emergency Medicine
Gary Smith, Royal College of Physicians, Intensive Care Society
Richard Williams, Royal College of Psychiatrists

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Other quality standards documents

A roadmap for the other documents which comprise the quality standards for cardiopulmonary resuscitation practice and training is shown below. Also included below are hyperlinks to access the other quality standards documents.

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 and with appropriate frequency to a level of proficiency appropriate to each individual’s expected role.

This document provides quality standards for cardiopulmonary resuscitation practice and training in the following settings:

1. Acute care - mainly acute hospitals
2. Primary care - general practice (including out-of-hours services)
3. Primary dental care - excluding conscious sedation for which there are existing standards
4. Community hospitals care - * (Documents currently in development)
5. Mental health - inpatient care.

The aim of these standards is to:

1. Improve care and outcomes for patients who are deteriorating, or suffer cardiorespiratory arrest in a healthcare setting.
2. Update existing quality standards with a particular emphasis on simplification to improve implementation.
3. Provide new standards for community hospital care and mental health inpatient care.

Whenever possible, reference will be made to existing national guidance.

These standards update and replace:

1. Cardiopulmonary Resuscitation - Standards for clinical practice and training. A joint statement from The Royal College of Anaesthetists, The Royal College of Physicians of London, the Intensive Care Society and the Resuscitation Council (UK). October 2004. Revised June 2008.
2. Cardiopulmonary Resuscitation Guidance for clinical practice and training in Primary Care. Resuscitation Council (UK). July 2001.
3. Medical Emergencies and Resuscitation - Standards for clinical practice and training for dental practitioners and dental care professionals in general dental practice. Resuscitation Council (UK) July 2006. Revised and updated February 2012.

There are numerous types of setting where clinical care is provided. This guidance does not provide standards for every possible setting or scenario. The standards in this document can be used to help guide development of standards in clinical settings that are not included in this document. Guidance relating to other settings may be added in the future.

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2. Core standards

The same core standards apply in all settings to ensure that:

1. the deteriorating patient is recognised early and there is an effective system to summon help in order to prevent cardiorespiratory arrest.
2. cardiorespiratory arrest is recognised early and cardiopulmonary resuscitation (CPR) is started immediately.
3. emergency assistance is summoned immediately, as soon as cardiorespiratory arrest is recognised, if help has not been summoned already.
4. defibrillation, if appropriate, is attempted within 3 minutes of identifying cardiorespiratory arrest.*
5. appropriate post-cardiorespiratory-arrest care is received by those who are resuscitated successfully. This includes safe transfer.
6. implementation of standards is measured continually and processes are in place to deal with any problems identified.
7. staff receive at least annual training and updates in CPR, based on their expected roles.
8. staff have an understanding of decisions relating to CPR.
9. appropriate equipment is available for resuscitation.

*Circumstances where this standard may not be achievable are included in the relevant section.

3. Methods

A working group was set up by the Resuscitation Council (UK). Stakeholder organisations nominated individuals to the working group. Existing standards in each area were identified and, where needed, the existing standards were updated. Updates were based on consensus from working group members.

The evidence for specific aspects of resuscitation practice comes from Resuscitation Council (UK) Guidelines 2015. The process used by the Resuscitation Council (UK) to produce the 2015 Resuscitation Guidelines was accredited by the National Institute for Health and Clinical Excellence (NICE) (http://www.resus.org.uk/guidelines-and-guidance).

The first draft was sent to organisations for comment and approval. The drafts and final version were also reviewed and commented on by the Resuscitation Council (UK) Patient Advisory Group.

A draft of each standard was posted on the Resuscitation Council (UK) website for at least 4 weeks. Feedback was reviewed by the working group and consensus reached on responses to any issues raised. Final documents were approved by the working group.

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4. Implementation

Where appropriate, each section contains links to implementation tools or examples of good practice. Each section also contains guidance on measures to assess adherence to standards.

Terminology:

1. The term ‘MUST’ has been used when the consensus is that the standard promotes normal practice and is obligatory.
2. The term ‘SHOULD’ has been used when the consensus is that the standard promotes normal practice.
3. The term ‘RECOMMENDS’ is used when the consensus is that the standard promotes best practice.

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5. Supporting information

1. Care Quality Commission.    http://www.cqc.org.uk
2. European Resuscitation Council Guidelines.   http://www.cprguidelines.eu
3. High Quality Care For All. NHS Next Stage Review Final Report. Department of Health. June 2008.
4. International Liaison Committee on Resuscitation. http://www.ilcor.org
5. Nolan J, Soar J, Eikeland H. The chain of survival. Resuscitation. 2006 Dec;71(3):270-1.
6. The NHS Constitution for England (2012 Edition)
7. Resuscitation Council (UK). http://www.resus.org.uk
8. Resuscitation Council (UK) Guidelines. http://www.resus.org.uk/guidelines-and-guidance

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6. APPENDIX: Conflict of interest declaration

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November 2013