The Resuscitation Council (UK) Chain of Survival has as a first link ‘Recognition and Calling for help to Prevent Cardiac Arrest’, NICE have Clinical Guidelines 50 which require NHS trusts to use a ‘track and trigger’ system and the NPSA have written about the Recognition of the Acutely Ill Patient. So with all this support why are we still attempting CPR where it is not appropriate? The NCEPOD report paints a bleak picture that the care ‘7 out of 10’ patients received was less than good, they highlight in the report simple actions that could have made a difference to the care received and these included earlier detection, escalating care and acting on the Early Warning Score. These are all areas where education and training can support. In my Medical Emergencies course I discuss this appropriate to your environment.
In my first blog I discussed the ABCDE approach which when used systematically can help in the detection and management of the deteriorating patient. Key to ensuring improvements in care is communication; communication with the patient so their wants and desires are understood and this requires an understanding of local and regional Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) policies and the Mental Capacity Act chapter 10. Colleagues need to be aware of treatment decisions made and these need to be shared appropriately whilst maintaining confidentiality. Also team members need to be able to communicate with senior colleagues so that care is escalated appropriately. One place where communication can be practised and skills developed in safety is in the Simulation Centre and this will be the subject of my next blog.
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