Resuscitation Training Requirements - Guidance for Adult

Publication: 01/10/2006  --
Last review: 25/03/2019  
Next review: 01/03/2022  
Clinical Guideline
CURRENT 
ID: 858 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2019  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Guidance for Resuscitation Training Requirements (Adult, Paediatric and Neonates)

  1. Introduction
  2. Scope and purpose of the guidance
  3. Staff Groups and Resuscitation training
  4. Levels of  Adult Resuscitation Training
  5. Levels of Paediatric Resuscitation Training
  6. Levels of Neonatal Resuscitation Training
  7. Record keeping and monitoring
  8. Evidence Base
  9. Appendix 1 - Table for Paediatric Resuscitation Training Requirements
  10. Appendix 2 - Table for Adult Resuscitation Training Requirements

Adult Resuscitation Training and Education Framework  (Please note this link will be deleted so if it is anywhere else it will need to be removed on the Leeds health pathways)

1. Introduction

The Leeds Teaching Hospitals (LTH) Trust’s Resuscitation Service is an overarching Trust-wide service which comprises of: an ‘Adult’ Resuscitation Service and a ‘Children’s’ Resuscitation Service. Both services are hosted and managed by the Adult Critical Care Clinical Service Unit (CSU).


The Leeds Children’s Hospital is part of the Leeds Teaching Hospitals (LTH) Trust. Unless indicated otherwise, this area will be referred to as the Children’s Hospital throughout the document.


1.1 The Leeds Teaching Hospitals NHS Trust supports all its employees working with patients to ensure they receive the appropriate level of resuscitation training and education and regular updates for maintaining a level of competence appropriate to each individual's employed role. The Resuscitation Council (UK) (2015) has set out clear quality standards of resuscitation training that are endorsed by the Leeds Teaching Hospitals NHS Trust.


Link to Resuscitation Council (UK) Quality Standards  Acute Care setting


1.2  In addition, standards set out in the NHS Litigation Authority (NHSLA) (2007) Risk Management Standards for Acute Trusts provide further background to this document to ensure that resuscitation policies and practice adhere to the principles of clinical governance.

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2. Scope and purpose of the guidance

2.1 This guidance sets out the level of resuscitation training and education and necessary resuscitation updates that must be undertaken by staff.

2.2 This guidance applies to all employees within the Leeds Teaching Hospitals NHS Trust who are involved in the transfer, care, clinical management and/or treatment of patients.  Throughout this document and from now on, unless referring to specific staff groups, the term staff is used to refer to employees within the Trust who deal with adult patients and also with neonates, new-borns, infants, children and young people (0-16 years*).  

2.3 Unless specified, the terms ‘Paediatric’ &/or ‘Child’ are both interchangeable generic terms referring to the above mentioned groups of children from 0-16 years*.

2.4 For the purpose of resuscitation, children are defined as: Neonates (babies born prematurely), New-borns (babies born at term), Infants (0 - I year), Children (1- 8 years) and young people (0 - 16*)

2.5 The Term ‘Obstetric’ refers to the heavily pregnant woman, for whom it may be necessary to place a ‘2222’ Obstetric Medical Emergency’ call.

* 0-16 years* In special circumstances young persons over 16 years remain under the care of Consultant paediatricians due to their illness pathway.

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3. Staff Groups and Resuscitation Training

3.1 All staff should undergo resuscitation training and/or education to a level appropriate for their expected clinical responsibilities (Resuscitation Council, UK, 2015).

3.2 Clinical staff caring for adults must be able to undertake cardiopulmonary resuscitation (CPR) and recognise cardiopulmonary arrest; summon help; start CPR using airway adjuncts; and, where appropriately trained, attempt defibrillation.

3.3 Clinical staff caring for neonates, new-borns, infants &/or children must be able to recognise and assess the seriously ill/ injured infant/child; summon help, commence effective new-born /paediatric CPR; and, where appropriately trained, attempt defibrillation.

3.4 The following training is delivered to staff requiring Level 2 training and above. This includes the use of a children’s early warning/’track and trigger’ system (Paediatric Advanced Warning Score), (PAWS/PEWS) to identify & manage the deteriorating infant/child, in order to prevent cardiopulmonary/cardiac arrest.

3.5 The Resuscitation Service will facilitate, deliver and audit the provision of resuscitation training and education.

3.6 All new members of staff must receive information regarding resuscitation training and/or education as part of their induction programme to a level appropriate for their clinical responsibilities.

3.7 There may be some staff groups that have resuscitation training requirements unique to their individual role that could not be identified readily within this guidance. Where this is the case individuals, following consultation with their line manager within the CSU, and any guidance stipulated by their national governing bodies, are responsible for consulting directly with the Resuscitation Service so that appropriate advice and training can be provided.

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4. Levels of resuscitation training and updates (Adults)

-           Basic Awareness Education: - Suitable for non-clinical staff.
Once only training

  • Corporate and/or Local Induction
  • Accessed through personal profile

 

  • Level 1(Adults) training and update: - Suitable for non-registered healthcare staff.

Annual update required.

  • Drop in session 08.00 - 16.00 Monday to Friday excluding BH
  • In hospital CPR assessment & appropriate actions
  • Location of emergency equipment
  • Good quality chest compressions
  • Assessed via Laerdal feedback manikins. Must achieve a minimum of 80% on chest compression accuracy to pass.

 

Level 2 Adult Immediate Life Support (ILS): - for FY1medical staff only

  • Taught in conjunction with the RAAPID course. Combined duration 7.5 hours (taught over 1 day)
  • Causes and prevention of cardiac arrest including local NEWS and SBARR.
  • Cardiac arrest trolley equipment awareness
  • Good quality chest compressions
  • Safe defibrillation (manual or AED)
  • Airway management to intermediate level, including i-gel supraglottic airway device, injector suction system and simple airway manouvers/adjuncts.
  • Team approach including human factors
  • The ALS algorithm and preparation for advanced life support


Level 2 Adult Resuscitation for Medical Staff: - Suitable for Consultants, all training and non-training grades with the exception of FY1 & FY2 medical staff. This is a 4 year certificate with a mandatory eLearning package to be completed after 2 years. At the end of the 4 years staff must do some sort of face to face training e.g. Level 2 or ALS course. Access to this course is done through the organisational Learning Training Calendar. After July 2019 this will be done through ESR.


Access the course through the Organisational Learning Training Calendar

  • Duration 2 hours
  • Update of Advanced Life Support Guidelines
  • Cardiac arrest trolley equipment awareness
  • Good quality chest compressions
  • Defibrillator use – manual and/or AED
  • Airway management include injector suction system, simple airway manoeuvres/adjuncts and insertion of i-gel supraglottic airway
  • Effective management of a cardiac arrest including human factors
  • Safe transfer post arrest
  • Anaphylaxis and Choking Management and Treatment
  • ReSPECT
  • If required Paediatric Basic Life Support (PBLS)


(Please see Paediatric Section for content)
Level 2 Adult Resuscitation for qualified non-medical staff: - Suitable for all clinical staff working with adult patients who would be required to initiate CPR and use a defibrillator. Annual update required. Access to this course is done through the organisational Learning Training Calendar. After July 2019 this will be done through ESR.


Annual update required.


Access the course through the Organisational Learning Training Calendar

  • Duration 2.5 hours
  • Cardiac arrest trolley equipment awareness
  • Assessment of the collapsed casualty
  • Good quality chest compressions
  • Defibrillator use – AED or manual depending on work area
  • Airway management include injector suction system, simple airway manoeuvres/adjuncts and insertion of i-gel supraglottic airway
  • Team approach pre and post cardiac arrest team arrival, including human factors
  • Post arrest assessment
  • Preparation for safe transfer post arrest
  • Anaphylaxis and Choking Management and Treatment
  • ReSPECT
  • If required Paediatric Basic Life Support (PBLS)


Level 3 Advanced Life Support Courses: - Mandatory for FY2 medical staff.


Resuscitation Council (UK) Advanced Life Support (ALS adults) - information via Pam Duffy, Resuscitation Services or www.resus.org.uk.


Contact Pam Duffy at pamela.duffy2@nhs.net for details of LTHT courses


If staff are from another hospital, they should attend a local induction with the Resuscitation Services Team even if they are ALS trained.

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5. Levels of Resuscitation Training and Updates (Paediatric)

 

Basic Awareness Education: Generic session for non-clinical staff, (OLM facilitate).  
 All non-clinical staff require Basic Awareness Education(e.g. clerical staff). This is delivered at Corporate and Local Induction and will include knowledge of local and Trust processes for summoning the appropriate Emergency Teams (as below)                           

Children's/ Paediatric Emergency Team
Neonatal Emergency Team
Obstetric Emergency Team
Children's/Paediatric Trauma Emergency Team
Adult Cardiac Arrest Team

The Trust guidance on updates is in line with current R.C(UK) (2015) recommendations. Thus Basic Awareness Educationwill be provided on induction and staff will be updated only when there is a change in practice, for example, when there is a change in Trust guidelines/policy.        

                                                  
 Level One: Basic Life Support (BLS): Paediatric, New-born/Obstetric & Neonatal. 

  •  
    • (1); Paediatric Basic Life Support (PBLS):

(This is also covered in Adult Level 2 or Paediatric Resuscitation Recognition)
This course is aimed at clinical staff specifically involved in the care Children who are either Allied Health Professionals (AHP’s) Such as: Physiotherapy/Occupational Therapists, Cardiac Technicians, or Theatre, Radiology staff & Children’s Hospital Nursing staff who are NOT Qualified Registered Children’s Nurses/Child Branch Nurses: e.g. Paediatric Nursery Nurses, Clinical Support Workers (CSW’s) - (Emergency department band 5 staff nurses and outpatient nurses are also included in this cohort). This course focuses on good quality resuscitation with the use of feedback devices and also itreatment of the choking infant and child.


5.1: (2). New Born/ Obstetric Basic Life Support (OBLS):


(This is delivered as part of the midwifery mandatory training day, facilitated by the midwifery clinical educators)


This course is aimed at all LTHT Qualified Midwives and CSW’s involved in the delivery of a new-born infant. (To avoid confusion with course 3 (bellow) this course is referred to as Obstetric Basic Life Support (OBLS). The T&E focuses upon the safe and effective transition from birth (Foetal circulation) to that of new-bornfull’ circulation. The T&E is interactive/scenario based. Simulations include: Assessment & appropriate management of the new-born infant at birth, Recognition of the deteriorating new-born infant, delivery of effective New-born Life Support, knowledge/use of mobile blended resuscitaire’s & emergency equipment use. Also includes mandatory equipment T&E for manual* defibrillation testing/defibrillation awareness.


(NB) all staff also caring for the heavily pregnant woman/adult must access appropriate Adult Resuscitation T&E - refer to section 4.3 of this document.


5.1: (3).Neonatal Basic Life Support (NBLS):


(This is delivered as part of the neonatal mandatory training day, facilitated by the neonatal clinical educators)


Staff eligible for this T&E includes all Qualified Neonatal & Transitional Care nursing staff, CSW’S & Neonatal Nursery Nurses. The intention of this T&E is to ensure: Early recognition and management of the sick and/or deteriorating premature/neonatal infant. The interactive and scenario based T&E incorporates specific situations which pose life -threat to this specialized population of premature infants. Specific skills required to manage an extremely premature baby/ deliver emergency Neonatal BLS are highlighted. Neonatal emergency equipment familiarisation including use of Resuscitaires/Neo-puff ventilatory support and manual* defibrillation testing/awareness is a standard course element.


*The Manual* Defibrillation of Infants and Children is recommended (RCUK 2015)
  

Level Two: Paediatric Resuscitation & Recognition


LEVEL 2:  EQUVALENT TO ’PAEDIATRIC LIFE SUPPORT (PLS) COURSE


5.2 (1) Resuscitation & Recognition (full day, once only)
The course is a 7.5 hour multi-disciplinary course.The course elements are standardized and  recognised  within LTHT. The Full day course should only be undertaken once. Staff must ensure mandatory training is undertaken annually/bi-annually by attendance on Resuscitation & Recognition half day update.


The course elements are structured around standardized national content and are designed to maximise ability to commence early and effective basic life support whilst stabilizing and preparing for and supporting Advanced Life Support teams on arrival and during an emergency event.


The course combines: short lectures with interactive learning strategies; Skills workshops & simulation of paediatric emergency events. The aim of the course is to provide delivery of key learning points/skills to ensure outcome for a deteriorating infant/child is maximised and morbidity and mortality reduced.


It includes: robust A-E Assessment & Recognition of the sick/Injured infant or child, Early & effective cardiopulmonary resuscitation/airway management. Coreis the use of Human Factors to enable: Good decision making, effective: team working, role allocation & delegation, communication & leadership, Application of NHS standardized tools as below: 

  • Paediatric Advanced Warning Scores (PAWS/PEWS).
  • SBAR Standard NHS Communication Tool. 
  •  Importance of Debrief post event.

WETFLAG and Paediatric Emergency Red Folder  


End Of Life Care: LTHT implementation of ReSPECT Document


Special Case Management includes: Emergency Management of:

  • Choking: conscious/Unconscious
  • Respiritory distress: Sepsis/ Asthma
  • Cardioversion (SVT)
  • Cardiac Arrhythmia
  • Fitting Child
  • Anaphylaxis

5.2 (2) Paediatric Resuscitation & Recognition level 2 ( Update):    
The Paediatric Resuscitation & Recognition course is 3 hour multi-disciplinary course. The course elements are taken from the RC(UK) and recognised within LTHT. The aim of the course is to ensure all are updated in regards to national changes in R.C(UK) content. In addition any changes to Regional/ Local policy & guidelines pertaining to the assessment & recognition of the deteriorating infant/child and/or ‘paediatric’ resuscitation will be disseminated.
All national R.C (UK) courses are standardized. Pre course work must be undertaken prior to course registration and attendance This is undertaken via the appropriate R.C (UK) ‘on-line’ Virtual Learning Environment (VLE).

Level Three: Advanced  Life Support Resuscitation Council (UK) Courses:

5.3: The following Level 3 courses are facilitated by the Paediatric Resuscitation Team at LTHT:

  1. European Paediatric Advanced Life Support (EPALS)
  2. Advanced Paediatric Life Support (APLS)
  3. New-born Life Support (NLS)*


All national R.C (UK) courses are standardized. Pre course work must be undertaken prior to course registration and attendance. This is undertaken via the appropriate R.C (UK) on line “Virtual Environment” (VLE).


As per Trust, R.C(UK) 2015 Guidelines & Health Care Professional Standards; the following staff require ‘role appropriate’ Level 3 Paediatric/ New-born Advanced Resuscitation T&E: The Children’s Resuscitation Service is available for specific advice as required. Criteria are provided Bellow:

  • All medical & nursing staff who are; Children’s Emergency Team Members, Children’s Emergency Trauma Team Members, or Neonatal Emergency Team Members.
  • All registered nurses/midwives who are undertaking ‘Advanced’ clinical/nursing practice, providing a high level of advanced life/respiratory support as specified in their job description.
  • All paediatric & neonatal doctors (ST3) as per Royal College of Paediatricians Education    Programme (STEPS)
  • All Band 6, 7 & 8 Children’s Nurses working in, & regularly in-charge of acute paediatric ward areas
  • All Paediatric Emergency Department (ED) nursing staff (B6/B7) INCLUDING staff who are not registered paediatric nurses, but who deal with acutely ill and injured children within LGI ED Resus Areas.

5.4 Paediatric Medical Staff Training:
Two options exist for Paediatric Consultants /senior medical staff who do not routinely carry a Children’s Emergency 2222 bleep and thus may not have also accessed a Level 3 Advanced Life support course for some time:


 The options available are outlined below:

  • Medical staff having undertaken a Full PILS day course (within the last 12-18 months) and’ or hold current Advanced PALS certification: The R.C(UK) recognize this national certification as  valid, accordingly Senior medical staff will be expected to continue to access the in house Paediatric Resuscitation & Recognition Level 2 course as their two yearly  mandatory requirement.
  • Medical staff who have not undertaken a Full PILS course and/or do not hold current Level 3 Advanced PALS certification: Staff can access the half day  Paediatric Resuscitation & Recognition Level 2 Update. Attendance will be registered on ESR as having attended an equivalent ‘in- house’ local Level 2 Resuscitation course (PMST). All core elements taught and assessed are of the same standard as the national RC(UK) PILS Update course.


N.B) Consultants are actively encouraged by the resuscitation department to organise PMST sessions for a cohort of colleagues annually by contacting the Children’s Resuscitation Team.  PMST is equivalent to the RC(UK)level 2 PILS Update and is an ‘in-house’ half day course.

5.5 Staff Groups


All Qualified ‘Paediatric Nursing Staff:


Nursing staff (Band 5/6/7/8) working in acute Children’s ward areas will be required to undertake Resuscitation & Recognition Level 2 (Full day) course as part of induction to the trust (Once only).


Paediatric Nursing Staff will access Paediatric Resuscitation & Recognition Level 2 half day update for all future annual updates.  


Emergency Department (ED) Nursing staff (Adult):


All Band 5-7nursing staff will undertake  Resuscitation & Recognition Full day course as  part of induction to the trust (Once only). Band 6-7 Nursing Staff will access Paediatric Resuscitation & Recognition Level 2 half day update for all future annual updates.
 Band 5 ED staff will access Paediatric Basic Life Support (Level 1) for all future annual updates. :


5.6 Clinical Staff New To The Trust


It is the responsibility of training leads within each CSU to inform new staff of their mandatory training requirements as designated via their role/position number. New Starter Reports are circulated by OLM to training leads monthly. In this way the Children’s Resuscitation Service are informed when new staff commence employment, so that resuscitation T&E can be provided in accordance with this guidance as organised by their training leads.

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6. Level of Resuscitation Training and Updates (Neonatal)

Staff involved in caring for newborn infants are required to undertake training in relation to newborn / neonatal resuscitation as identified in the Maternity Services job specific Training Policy training needs analysis. 

Staff may also undertake further training in relation to neonatal resuscitation via Neonatal Life Support (NLS) course (please refer to Resuscitation Education and Training, LTHT 2014).

Staff who may undertake this additional training are:

  • Delivery Suite Coordinators (Band 7)
  • Core staff working on delivery suite
  • Rotational Midwives (if identified as relevant on their PDP)
  • Community Midwives (if identified as relevant on their PDP)
  • Neonatal Medical/Nursing Staff Nurses

Some senior staff may also undertake the Resuscitation Council UK ARNI ( Advanced resuscitation of the newborn infant) course which is run in Leeds twice per year. This is ideal for Tier 2 doctors, consultants, ANNPs and band 6/7 nurses.

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7. Record keeping and monitoring

7.1 CSU responsibilities
(a) All CSU’s are responsible for ensuring that their staff are trained in accordance with this guidance.
(b) Each Directorate Team must inform the Resuscitation Service when staff have been trained by sources other than the Resuscitation Service (e.g. training provided by key trainers, attendance at external courses such as ALS) in order for the Resuscitation Service to maintain a central database.


7.2 Resuscitation Service responsibilities
(a) Resuscitation Service is responsible for maintaining accurate and current records of all resuscitation training in a central database (ESR) in accordance with data protection legislation

7.3 Individual responsibilities
(a) All staff are responsible for keeping their skills up to date in accordance with this policy and informing their line managers at annual appraisal when training requires updating.
(b) All staff are required to maintain individual records of training.

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Provenance

Record: 858
Objective:
Clinical condition:
Target patient group: All staff caring for adult patients
Target professional group(s): All Secondary Healthcare Professionals
Registered Nurses Working in Critical Care
Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

8. Evidence Base

  1. Resuscitation Council (UK) (2015) Cardiopulmonary Resuscitation. Standards for Clinical Practice and Training. Resuscitation Council UK, London.
    https://www.resus.org.uk/quality-standards/acute-care-quality-standards-for-cpr/
  2. Resuscitation Council (UK) (2015) Resuscitation Guidelines. Resuscitation Council UK, London.  www.resus.org.uk
  3. Department of Health (2012) National Service Framework for Children: Getting the Right Start. Standard for Hospital Services, Department of Health, London.
  4. British Association of Perinatal Medicine (2010) Service Standards for Hospitals providing Neonatal Care.
  5. Paediatric Intensive Care Society (2016) Paediatric Intensive Care Standards.
  6. Royal College of Paediatrics and Child Health (2007/2012) Standards for Children and Young People in Emergency Care Settings.
  7. Royal College of Paediatrics and Child Health (2015) Facing the future: Standards for Acute Paediatric General Services.
  8. National Institute of Clinical Excellence (2014) The Confidential Enquiry into Stillbirths and Deaths in Infancy.
  9. Advanced Life Support Group (2015) Advanced Paediatric Life Support: A Practical. Approach to Emergencies. Wiley Blackwell, Sixth Edition.
  10. NHS Litigation Authority (NHSLA) (2010) Risk Management Standards for Acute Trusts. Willis, Bristol.
  11. NHS Litigation Authority (NHSLA): Maternity Clinical Risk Management Standards, (2010- 2013)
  12. Mothers and Babies: Reducing risk through audits and confidential enquiries across the UK (MBRACE-UK) 2016. 
  13. Resuscitation Council (UK) (2015) Resuscitation Guidelines. Resuscitation Council UK, London.
  14. National Institute of Clinical Excellence (2019) Acutely Ill Patients in Hospital, Recognition of and Response to Acute Illness in Adults in Hospital. NICE Guideline 50.
  15. The Foundation Programme Committee of the Academy of Medical Royal Colleges, in cooperation with Modernising Medical Careers in the Departments of Health (2016) Curriculum for the Foundation Years in Postgraduate Education and Training.

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9. Appendix 1 - Table for Paediatric Resuscitation Training Requirements

10. Appendix 2 - Table for Adult Resuscitation Training Requirements

 

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Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Not supplied

Equity and Diversity

The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.