Children S Resuscitation Guidance for Care Workers

Crossroads CareChildren’s resuscitation guidance

C.04c

Children’s resuscitation guidance for care workers

1.0 SCOPE

1.1 This guidancerelates to children and young peopleaged 17 and under. There is separate guidance (B.03c)for people aged 18 and over.

1.2 The intended outcome of this documentis to ensure each child or young person to whom it applies receives prompt, effective resuscitation provision in line with their individual requirements.

1.3 Pending the development of guidance specific to volunteers, this guidance will apply to all volunteers (including trustees) to the extent that the content is relevant to them in the course of their volunteer work with Crossroads Care.

1.4 Crossroads Care recognises the added value that volunteers can bring to its services and this is reflected by the wide variety of roles they perform. However, the nature of the organisation’s relationship with volunteers is very different to the one it has with paid employees. Volunteers will not:

provide personal care services / support with medication in people’s homes (see Crossroads Care’s policies on personal care and medication)
undertake roles where the prompt attendance of the volunteer at a specified time / venue is essential to the safety or wellbeing of a service user.

2.0 DEFINITIONS

2.1 Appendix 1 at the end of this document provides definitions of the following terms:

resuscitation
cardio-pulmonary resuscitation (CPR)
basic life support
Do Not Attempt Resuscitation (DNAR) / Do Not Resuscitate (DNR) instructions
Advance Decisions
terminal illness
palliative care
end of life care
anaphylactic shock.

3.0 EMERGENCY SITUATIONS

3.1 If a child or young person suddenly or unexpectedly stops breathing or their heart stops whilst you are working with them, you are required to:

start resuscitation whilst you wait for the emergency services to arrive
summon the emergency services by calling 999
inform your line manager / the person on call what has happened.

3.2 You will be trained in resuscitation techniques(including basic CPR and the treatment of anaphylactic shock), and it is our policy that you provide this support until the emergency services arrive.

3.3 Where the decision has been taken that emergency resuscitation is not appropriate for a particular child or young person, your line manager will let you know and instructions will be clearly written in their care plan.

4.0 CARE PLANS

4.1If the child or young person you care for has problems with their heart or breathing, the care planner will find out what treatment they and their family want them to receive. The care plan will then give all the details of what action you need to take if the child or young person’s heart or breathing stops.

4.2 The care plan will also state whether the child or young person has any known serious allergies that might result in anaphylactic shock and what actions you need to take if this happens (see also 6.1 below).

4.3The care planner will routinely review and update care plans every year or sooner if a child or young person’s circumstances or health change. If you notice that a person’s care plan contains out-of-date information, let your line manager know straight away.

5.0 DNAR / DNR INSTRUCTIONS

5.1Resuscitation, including CPR, is not appropriate for all children or young peoplewho have problems with their heart or breathing. If achild or young person is terminally ill or is very weak and frail, the decision may be taken to allow them to die in peace rather than to put them through the trauma of CPR.

5.2 Some children or young people receiving care may have a DNAR / DNR instruction in place that states they and / or their family do not want them to be resuscitated.If this is the case, the care planner will check that the DNAR / DNR instruction is legal and valid before you start to provide a service.

5.3 Details of the DNAR / DNR instruction will be written in the care plan, including where within the home the original document is located.

5.4If you try to resuscitate a child or young person when there is a DNAR / DNR instruction in place, your actions could be interpreted as physical assault. You have to respect their or their family’s wishes.

5.5 Unless the care plan tells you otherwise (see 5.6 below), if a child or young person has a DNAR / DNR instruction in place and theysuddenly or unexpectedly collapse:

summon the emergency services immediately by calling 999
when the emergency services arrive, tell them about the DNAR / DNR instruction straight away.

5.6However, the family may have asked that, if the child or young person’s heart or breathing stop, you do not call for an ambulance but instead you contact their parent / carer or other family member. All the details will be written in the care plan. If this happens to you, contact your line manager / the person on call straight away and they willgive you the help and support you need.

5.7Just because a child or young person has ADNAR / DNR instruction, this does not mean that all other treatment stops.You are still expected to give them all the care they need, as directed in the care plan in order to keep them as comfortable as possible.

5.8 If you are caring for a child or young person with a DNAR / DNR instruction, and you are concerned about it or have anyquestions, get in touch with your line manager to discuss it with them.

5.9 You may opt out of providing palliative care or end of life care or care for those with DNAR / DNR instructions with no penalty, although this may affect the amount of work Crossroads Care is able to offer to you.

6.0 anaphylactic shock

6.1As part of your first aid training you will be taught how to deal with anaphylactic shock, including how to givemedication using an EpiPen. If the child or young person experiencing anaphylactic shock does not have an EpiPen:

summon an ambulanceimmediately by calling 999
contact your line manager / the person on call for further guidance.

7.0 What to do in the event of a death

7.1 If you suspect that a child or young person has died:

follow emergency first aid procedures unless restrictions apply (see 5.0 above)
contact the emergency services, unless otherwise instructed (see 5.4 above)
contact your line manager / the person on call.

7.2 Your line manager / the person on call will sort out who is going to contact the child or young person’s parent/s or next of kin and GP.

7.3 If you have been in a situation involving resuscitation or sudden death of a child or young person you will be offered support, by your line manager or other senior staff member. You might also want to contact FirstAssist who offer Crossroads Care staff a confidential, independent counselling and support service;. Their details are given in Appendix 2 at the end of this document.

8.0 Confidentiality

8.1 If a child or young person has a DNAR / DNR instruction in place, managers will make sure that all staff members working with them are fully aware of their / their family’s wishes. If you are aware that another staff member who needs to know has not been given this information then please let your line manager know.

8.2 Make sure you followCrossroads Care’sguidance on data protection (A.03d) and confidentiality (D.11c) at all times.If you don’t the matter be dealt with under the disciplinary policy.

9.0 record keeping and reporting

9.1 If you or a service user has an accident or you witness an accident or incident at work (including resuscitation events or deaths), report it to your line manager / the person on call immediately and record the incident on the client report form in the home. You line manager will let you know what other paperwork you need to fill in, which will include an incident report form (DT.03).

10.0 LEARNING AND DEVELOPMENT

10.1 General learning and development requirements relevant to the children’s resuscitation policy, procedure and guidance are contained in the learning and development guidance (E.13). Additional specific training information is documented below.

10.2 You will be given first aid training (including children’s emergency life support and CPR) as part of your induction training and it will be updated at least every three years. It is an insurance requirement that you do this.

11.0 ACCEPTANCE OF CHILDREN’S RESUSCITATION GUIDANCE

11.1 You are required to sign to indicate that you have received, read and understood the content of the children’s resuscitation guidance as directed by your line manager.

11.2 On completion of training, it is your personal responsibility to follow the children’s resuscitation guidance. Failure to do so may result in disciplinary proceedings.

APPENDIX 1

DEFINITIONS

1. Resuscitation is the term used for the emergency treatment needed to overcome the failure of breathing and circulation. It may consist of opening the airway and placing the child or young person in the recovery position or it may involve basic cardiopulmonary resuscitation.

2. Cardio-pulmonary resuscitation (CPR) is defined as the measures initiated to provide effective ventilation and circulation when a person’s respiration and heartbeat have stopped. These measures includemouth-to-mouth breathing and chest compressions to restart and maintain circulation.

3. Basic life support is the first stage of resuscitation and implies no equipment is employed.

4. A Do Not Attempt Resuscitation (DNAR) or Do Not Resuscitate (DNR) instruction refers to a decision not to attempt cardio-pulmonary resuscitation if a person’s heart stops or they stop breathing. This instruction can only be issued by the child or young person’s medical team (for example their consultant or General Practitioner). Further details are available at:

5. Terminal illness means any illness that ends in death. There is no possibility of recovery.

6. Palliative care is the combination of active and compassionate therapies aimed at reducing the symptoms and suffering of children or young people and families facing a life-threatening illness.

7. End of life care is an important part of palliative care, and usually refers to the care of a child or young person during the last part of their life, from the point at which it has become clear that they are in a progressive state of decline.

8. anaphylactic shock is a sudden, severe allergic reaction to a foreign substance, such as a drug, some foods or bee venom. When it happens:

the child or young person’s blood pressure will drop sharply
they may get itching welts on the skin
they will experience breathing difficulties.

The reaction may be fatal if the child or young person does not get emergency treatment immediately.

APPENDIX 2

FIRSTASSIST TELEPHONE COUNSELLING SERVICE

FirstAssist provides a confidential British Association for Counselling and Psychotherapy (BACP) accredited service and is the UK’s leading provider of telephone counselling services. Each telephone counsellor is a direct employee of FirstAssist and is trained to diploma of counselling (or equivalent) as a minimum qualification. All FirstAssist counsellors have at least two years post-qualifying, clinically supervised, counselling experience.

By employing the right quality and quantity of telephone counsellors, FirstAssist provides a powerful and effective counselling service via the telephone.

Each telephone counselling session can last for up to 50 minutes and the caller can continue to work with their counsellor on an ongoing basis; scheduling convenient appointments for each session.

Research has shown that telephone counselling can be at least as effective as that delivered face to face. In addition, this proven method offers callers the combination of convenience and, where desired, anonymity.

FirstAssist counsellors can work with a wide range of issues, including (but not limited to):

relationship difficulties
bereavement
stress
anxiety
emotional problems
work related issues
family difficulties
debt

All telephone counsellors are subject to formal monthly clinical supervision as well as having 24 hour access to a clinical supervisor for times of particular need. All supervision is provided by a team of FirstAssist clinical supervisors.

The contact details for this service are:

Telephone number 01455 251 500

Quoting scheme number 71422

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Policy/Childrenresuscitation/2011/11/APc004cLast updated October 2013