Resuscitation Council (UK)
Mental health - Inpatient care - equipment and drug lists

Quality standards for cardiopulmonary resuscitation practice and training

Mental health - Inpatient care - equipment and drug lists

 

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 in settings that deliver mental health inpatient care. 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 suctioning 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.
    • 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.).
    • 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.
    • 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 Service Structure or a designated resuscitation lead. Expert advice should also be sought locally from those involved frequently 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
    • 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 patient scenarios.
  13. The precise availability of equipment and drugs should be determined locally. The lists include a suggestion on the immediacy with which equipment and drugs should be available:
    • Immediate - available for use within the first minutes of cardiorespiratory arrest (i.e. at the start of the resuscitation)
    • Accessible - available for prompt use when the need is determined by the resuscitation team.
  14. These lists are not exhaustive. Local experts should be consulted to ensure the appropriate equipment and drugs are available when they are needed, to enable provision of high-quality attempted resuscitation.

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3. Mental health inpatient care – ADULT

Mental Health Inpatient Care – ADULT    

AIRWAY AND BREATHING

Item
Suggested availability
Comments
Ligature Cutter  Immediate  
Pocket mask with oxygen port, and oxygen tubing  Immediate  
Oxygen mask with reservoir, and oxygen tubing  Immediate  
Self-inflating bag with reservoir, and oxygen tubing  Immediate  
Clear face masks, sizes 3, 4, 5  Immediate  For use with self-inflating bag 
Oropharyngeal airways, sizes 2, 3, 4  Immediate   
Nasopharyngeal airways, sizes 6, 7 (and lubrication) Immediate  Will depend on local policy and staff training 
Portable suction (battery or manual) with Yankauer sucker and soft suction catheters
Immediate  Airway suction equipment. NPSA Signal. Reference number 1309. February 2011 
Supraglottic airway device with syringes, lubrication and ties/tapes/scissors as appropriate  Immediate/Accessible  Choice of device (e.g. laryngeal mask airway, i-gel®, laryngeal tube) and size will depend on local policy and staff training
Oxygen cylinder (with key where necessary)
Immediate  
Laryngoscope and Magill forceps Immediate Will depend on local policy and staff training 
Stethoscope  Immediate  


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Mental Health Inpatient Care – ADULT

CIRCULATION

Item
Suggested availability
Comments
Automated external defibrillator (AED)Manual defibrillator and/or AED for ECT departments  Immediate  Type of defibrillator and locations determined by a local risk assessment. Available to enable shock within 3 minutes of collapse.
Adhesive defibrillator pads x 2 packs  Immediate   
Razor  Immediate  Secure units must have a risk assessment 
ECG electrodes  Immediate  If monitoring devices are available 
Large heavy-duty scissors (e.g. ‘Tuff Cut’)  Immediate  Secure units must have a risk assessment 
Intravenous cannulae (selection of sizes) and 2% chlorhexidine/alcohol wipes, tourniquets and cannula dressings  Immediate/Accessible Will depend on local policy and staff training 
Adhesive tape  Immediate/Accessible   
Intravenous infusion set  Accessible  Will depend on local policy and staff training 
0.9% sodium chloride (1000 ml)  Accessible   Amount depends on access to further fluids 
Selection of needles and syringes  Accessible  Will depend on local policy and staff training 
Intraosseous access device  Accessible   Will depend on local policy and staff training 
Dressing Pads x 2  Immediate   


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Mental Health Inpatient Care – ADULT     

OTHER ITEMS

Item
Suggested availability
Comments
Clock/timer Accessible   
Gloves, aprons, eye protection  Immediate Further personal protective equipment may be required according to local policy 
Nasogastric tube  Accessible  Will depend on local policy and staff training 
Sharps container and clinical waste bag  Immediate  Sharps container must be immediately available wherever sharps used 
2% chlorhexidine / alcohol wipes  Accessible   
Blood sample tubes  Accessible   
Blood glucose analyser with appropriate strips  Accessible  According to local policy
Manual handling equipment  Accessible  According to setting. See Guidance for safer handling during resuscitation in healthcare settings
Cardiorespiratory arrest record forms for patient notes, Audit forms and CPR decision forms  Accessible   
Access to algorithms, emergency drug doses  Accessible   


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Mental Health Inpatient Care – ADULT

CARDIAC ARREST DRUGS – FIRST LINE for intravenous use !

Item
Suggested availability
Comments
Adrenaline 1mg (= 10 ml 1:10,000) IV as a prefilled syringe x 3  Immediate  Number of syringes depends on access to further syringes.
1 syringe needed for each 4-5 min of CPR.
Will depend on local policy and staff training 
Amiodarone 300mg as a prefilled syringe x1  Accessible  First dose required after 3 defibrillation attempts.
Will depend on local policy and staff training

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Mental Health Inpatient Care – ADULT     

OTHER DRUGS

Item
Suggested availability
Comments
Adrenaline 1mg (1 ml 1:1000) Immediate  First line for anaphylaxis - 0.5 mg intramuscular injection in adults 
Chlorphenamine 10 mg x 1  Accessible  Second line for anaphylaxis, can also be given intramuscularly. Will depend on local policy and staff training
Hydrocortisone 100 mg x 2  Accessible  Second line for anaphylaxis, can also be given intramuscularly. Will depend on local policy and staff training
Aspirin 300 mg  Accessible  For acute coronary syndrome. Will depend on local policy and staff training
Furosemide 50 mg IV x 2  Accessible  Will depend on local policy and staff training 
Flumazenil 0.5 mg IV x 2  Accessible  Will depend on local policy and staff training 
Naloxone 400 micrograms x 5  Accessible  For intamuscular or intravenous use. Will depend on local policy and staff training
Midazolam for buccal administration  Accessible  Drug preparation and use will depend on local policy and staff training 
Glucagon 1 mg x 1
Accessible  For intamuscular or intravenous use. Will depend on local policy and staff training
GTN spray  Accessible   
Ipratropium bromide 500 microgram nebules x 2 (and nebulizer device)  Accessible  Will depend on local policy and staff training 
Salbutamol 5 mg nebules x 2 (and nebulizer device)  Accessible  Will depend on local policy and staff training 

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NOTES: Mental Health Inpatient Care – ADULT

  1. A  999 ambulance must be called for any cardiorespiratory arrest unless there is a local Resuscitation team available.

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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4. Mental health inpatient care – PAEDIATRIC

Mental Health Inpatient Care – PAEDIATRIC

AIRWAY AND BREATHING

Item
Suggested availability
Comments
Pocket mask with oxygen port & oxygen tubing – paediatric and adult  Immediate  Will depend on local policy and staff training 
Oxygen mask with reservoir & oxygen tubing – paediatric and adult  Immediate   Will depend on local policy and staff training 
Self-inflating bag with reservoir & oxygen tubing – paediatric and adult  Immediate   Will depend on local policy and staff training 
Clear face masks size 00, 0, 1, 2, 3, 4  Immediate  
For use with self-inflating bag. Sizes and need to be determined according to local policy.
Oropharyngeal airways size 0, 1 and tongue depressor  Immediate    Will depend on local policy and staff training
Portable suction (battery or manual) with Yankauer sucker (paediatric and adult) and soft suction catheters, sizes 6, 8, 10, 12, 14  Immediate  Soft suction catheters will be dependant on suction device available 
Oxygen cylinder (with key if necessary)  Immediate   
Laryngoscope and Magill forceps Immediate  Will depend on local policy and staff training


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Mental Health Inpatient Care – PAEDIATRIC

CIRCULATION

Item
Suggested availability
Comments
Defibrillator 
- Manual defibrillator and/or AED
Immediate  Type of defibrillator and locations decided by a local risk assessment. AEDs are not suitable for infants (less than 12 months old) and this should be considered at risk assessment 
Adhesive defibrillator pads – paediatric and adult sizes  Immediate  Spare set of pads also recommended 
Intravenous cannulae (sizes 14, 16, 18, 20, 22, 24G) and 2% chlorhexidine / alcohol wipes, tourniquets and dressings  Accessible  Will depend on local policy and staff training 
Adhesive tape  Accessible   
Intravenous infusion sets (with and without incorporated burette)  Accessible  Will depend on local policy and staff training 
IV extension set with 3-way taps and bungs  Accessible  Will depend on local policy and staff training 
0.9% sodium chloride  Accessible  Will depend on local policy and staff training 
10% Dextrose  Accessible   
Selection of needles and syringes  Accessible   
Intraosseous access device with needles suitable for children and adults  Accessible  Will depend on local policy and staff training 


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          Mental Health Inpatient Care – PAEDIATRIC     

CARDIAC ARREST DRUGS – FIRST LINE for intravenous use !

Item
Suggested availability
Comments
Adrenaline 1mg (= 10 ml 1:10,000) prefilled syringe(s)*
Immediate  According to local policy 
Chlorphenamine 10 mg x 2*  Accessible  Second line for anaphylaxis. For intamuscular or intravenous use. Will depend on local policy and staff training
Hydrocortisone 100 mg x 2*  Accessible  Second line for anaphylaxis. For intamuscular or intravenous use. Will depend on local policy and staff training


* These lists refer to drug availability and not to the doses used for the treatment of children. Correct dosing is available at http://resus.org.uk/resuscitation-guidelines/

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Mental Health Inpatient Care – PAEDIATRIC        

OTHER ITEMS

Item
Suggested availability
Comments
Clock / timer
Accessible   
Gloves, aprons, eye protection  Immediate   
Manual handling equipment  Accessible  According to setting. See Guidance for safer handling during resuscitation in healthcare settings
Cardiac arrest record form for patient notes and audit forms  Accessible   
Access to algorithms, emergency drug doses, paediatric drug dose calculators (e.g. Broselow tape)  Immediate  According to local policy 


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          Mental Health Inpatient Care – PAEDIATRIC        

OTHER EMERGENCY DRUGS

Item
Suggested availability
Comments
Adrenaline 1mg (1 ml 1:1000)*  Immediate  First line for anaphylaxis for intramuscular use 
Glucagon 1 mg x 1*  Accessible  For intamuscular or intravenous use. Will depend on local policy and staff training
Salbutamol 5mg nebules x 2 (and nebulizer device) *  Accessible  Will depend on local policy and staff training 


* These lists refer to drug availability and not to the doses used for the treatment of children. Correct dosing is available at http://resus.org.uk/resuscitation-guidelines/

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NOTES - Mental Health Inpatient Care – PAEDIATRIC

  1. A 999 ambulance must be called for any  cardiorespiratory arrest unless there is a local Resuscitation Team available.

Supporting information

  1. 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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May 2014, updated May 2017

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