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  • 11 Feb 2013 9:05 PM | Anonymous member

    Background, Responsibility and Implications for PACU Practitioner and Nurse led extubation

    by

    Sarah Dawkins




    Background, Responsibility and Implications for PACU Practitioner and Nurse led extubation 


    Introduction

    A review of current literature highlighted the lack of national or local guidelines for Post Anaesthetic Care Unit (PACU) Practitioners/Recovery Room Nurses to extubate their own patients.  Extubation is described as the discontinuation of an artificial airway.  An artificial airway can be described as a plastic or rubber device that can be inserted into the upper or lower respiratory tract to facilitate ventilation or the removal of secretions (Farlex Inc 2011).

    Reviewing the Code of Professional Conduct (Nursing and Midwifery Council (NMC 2008)  and the Health Professional Council (HPC 2008) raised concern about practice with regards to extubating post-operative patients.  The NMC and HPC both state that as professionals, we are personally accountable for actions and omissions within our practice, must always be able to justify our decisions, act lawfully, deliver care based on best available evidence, act as an advocate and treat people with dignity.  Failure to comply with the code may bring fitness to practise into question and endanger registration.  


    Literature Review

    A systematic literature review of patient extubation by PACU Nurses was undertaken.  Systematic literature reviews optimise practice from the evidence of effectiveness and efficiency within the field of Health Care (Black et al 2000) and Gray (2001) suggests that a critically assessed, high quality literature review forms the basis of evidence based clinical practice.  

    As suggested by Aveyard (2007) and Cronin et al (2008), the first stage in conducting a literature review is to identify an appropriate topic.  The topic for this literature review was “PACU Practitioner/ Nurse led patient extubation for Endotracheal tubes (ETT’s)”.  Electronic literature only was reviewed due to timescales. .  Electronic searching is quick and convenient, allowing for articles to be sourced more rapidly than alternative methods (Page 2008). 

    The literature review was undertaken with a view to producing an evidence based, best practice guideline booklet for PACU Practitioners (Nurses, Nursing students, Operating Department Practitioners (ODP), ODP students and trainee Doctors) working within the PACU area, that are involved in patient extubation with EndoTracheal Tubes (ETT).   The Association of Anaesthetists of Great Britain and Ireland guidelines (AAGBI 2002) and the American Association for Respiratory Care (AARC 2007) for general ETT extubation were also read for pertinent information.  

    The Department of Health (DoH 2001) published A Framework for Lifelong Learning in the NHS.  It states that as Nurses, we need to be able to reflect, evaluate and modify our practice, ensuring that we are up to date and with current research and legislation. Gray (2009) suggests that a critically assessed, high quality literature review forms the basis of evidence based clinical practice.  

    The first review of the literature highlighted a lack of national guidelines and standards for Nurses/Perioperative Practitioner to undertake ETT extubation, however The Association of Anaesthetists of Great Britain and Ireland (2002) stated that an appropriately trained Nurse may remove a Laryngeal Mask Airway (LMA) but that an Anaesthetist must remove an Endotracheal Tube.  


    Delegation

    The Anaesthetist that administers the anaesthetic remains responsible for the removal of the ETT from the patient, whether that is within the Theatre or PACU setting (AAGBI 2002).  The Association for Perioperative Practitioners (AfPP 2007) recommend that if the responsibility is delegated to a PACU Practitioner, that the practitioner should have received validated training and be deemed competent to perform the task.  As no national, validated training package is available for PACU Practitioners, a local training package to develop and validate knowledge and skills around airway management was developed by myself following a systematic literature review and discussions with local Consultant Anaesthetists. 

    Delegation is a two way process.  If an Anaesthetist delegates an intubated patient to the care of a PACU Practitioner and they accept that delegation, that practitioner must have the knowledge and skills to be aware of the consequences of the delegation.  Their performance in this skill will be judged against the performance expected by Anaesthetists. The person to whom the task is delegated has a duty to inform the Anaesthetist delegating the task if the task is outside their area of competence (Burnard, Morrison 1994).

    The AAGBI guidelines (2002) further state that when care or treatment is delegated, the Anaesthetist must be satisfied that the person to whom they delegate has the qualifications, experience, knowledge and skills to provide the care or treatment involved and that the Anaesthetist must always pass on enough information about the patient and the treatment they need, as they will still be responsible for the overall management of the patient.


    Complications

    According to Rassam et al (2005) and Karmarker and Varshney (2008), airway related complications at extubation, are more common than problems at intubation, many aspects of which are controversial with no clear guidelines, giving cause for concern for patient safety and training.  Reviewing the numerous complications that can arise in the immediate post extubation period reinforces the responsibility for the individual undertaking the extubation and is a critical time for vigilant nursing assessment and care (Ead 2004).  Airway complications include; laryngospasm, laryngeal oedema, bronchospasm, aspiration and pulmonary oedema as well as anatomical changes, including short neck, sleep apnoea, cleft palate, small chin and obesity.

    The New NHS (DoH 1997) made it clear that practitioners must accept responsibility for developing and maintaining standards within their local NHS organisations.  The AAGBI (2002) state that practical training and maintenance of skills must supplement theoretical knowledge and training should be tailored to meet the needs of the individual and recovery room.  Providing suitably trained practitioners would cover the Clinical Governance aspects specific to education, training and continuous professional development.  


    Cardiac Patients

    By broadening the literature review search to include cardiac surgery some articles around Nurse led, fast track extubation of cardiac patients were found with documented protocols to perform patient extubation within ICU settings. The criteria for extubating cardiac patients is comprehensive and involves blood loss, blood pressure, heart rate and rhythm, arterial blood gases, sedation breaks, ventilator weaning procedures, respiration rates, neurological assessment and medication.  Once all those criteria are satisfactory, the protocol dictates how the patient should be extubated ie, with the trailing suction catheter.  If Nurses were able to follow an agreed protocol to be able to extubate patients in the ICU setting, could those skills be transferrable to the PACU setting?  


    The PACU Practitioner

    It was deemed that in order to undertake patient extubation, knowledge of the patient’s anatomy and physiology was needed.  This includes airway anatomy, inspired oxygen concentration, pulse oximetry, tidal volume, hypoxia and expired carbon dioxide as well as heart anatomy and physiology, heart rate and blood pressure.  The PACU Practitioner also needs to understand how to maintain a clear airway as well as how to manage an airway obstruction ie. undertaking an effective head tilt, chin lift,  jaw thrust, inserting appropriate nasal and/or oral airways and the use of suction.  Knowledge of pharmacology related to anaesthesia and analgesia is required to enable the PACU Practitioner to safely extubate a patient.  For example, recurarisation is a phenomenon of recurrence of neuromuscular block and it may occur where the reversal agents wear off before a neuromuscular blocking drug is completely cleared (Schultheis 1989).  This is important to understand as it has implications for airway management.  The PACU Practitioner also needs to understand the differences and implications of Total IntraVenous Anaesthesia (TIVA), which can cause apnoea and hypotension and gaseous anaesthetics which increase nausea and vomiting, in order to manage the extubation process.

    When preparing to extubate a patient, clinical considerations for the possible management of post extubation hypoventilation, airway compromise and obstruction should be taken into account.  Clinical practice standards for endotracheal tube removal include attentive post extubation monitoring, prompt identification of respiratory distress, maintenance of a patent airway and, if clinically indicated, attempts to successfully establish an artificial airway by reintubation or in rare situations, surgical technique (AARC 2007).

    Airway obstruction in the conscious patient is easily recognised as it leads to strenuous efforts on the part of the patient to overcome it.  However, airway obstruction in the unconscious patient may not exhibit classical compensatory signs. Paradoxical chest movement, where the upper abdomen and chest see-saw (the chest retracting and the abdomen sticking out) during attempted inspiration can be seen.  Air movement cannot be detected by listening at the mouth due to the lack of air entry and exit.  The patient will eventually become cyanosed if left untreated.


    Conclusion and limitations of the Literature Review

    The literature review has a number of severe limitations. The most valid and high quality literature reviews are normally conducted by a team of experienced researchers who have access to a wide range of skills, experience and knowledge.  This review could have been significantly strengthened if it was conducted with the support of a team to duplicate the literature search and validate the application of inclusion criteria and critical appraisal in order to minimise the risk of bias.  In addition, the sources of literature were focused entirely on electronic sources and therefore many other potential sources of relevant literature were not considered.


    Changes to Practice

    Following the systematic literature review, Consultant Anaesthetists were liaised with and the information gained with regards to extubation, was utilised.  A PACU Practitioners guide to extubation was subsequently written. This literature review informs the written guidelines in respect of Privacy and Dignity, Administration of Medicines, Safety in the Environment and Safeguarding Vulnerable Adults in relation to the DoH’s Essence of Care (DoH 2010).  A comprehensive flow chart with the essential information with regards to patient extubation with ETT’s as a quick reference guide for the Nurses to refer to, was then developed from the information realised from the literature review.

    Once the PACU Practitioner guidelines were written, the Airway Management training, including knowledge, skills and competency assessment was developed after liaising with the Anaesthetists. These are in relation to the ability to maintain a patent airway, ventilate a patient, use of artificial airways (oral/nasal/i-gel LMA) and through discussion around causes and management of airway obstructions.

    Whilst there remains a lack of national guidance for PACU Practitioners to extubate patients, the local guidance now written will standardise practice and give guidance on dealing with the problems that they face on a daily basis.

    The actual PACU Practitioner/Nurse led extubation guidelines handbook, algorithm and competencies can be purchased from   

    http://sarahdawkinshealthconsultancy.com/product/



    REFERENCES

    American Association of Respiratory Care  2007 AARC Guideline: Removal of the Endotracheal Tube Respiratory Care  Vol 52  (1)

    Association of Anaesthetists of Great Britain & Ireland 2002 Immediate Postanaesthetic Recovery  London  The Association of Anaesthetists of Great Britain and Ireland

    Aveyard H 2007 Doing a literature review  Maidenhead  Open University Press

    Black N, Brazier J, Fitzpatrick R, Reeves B 2000 Health Service Research Methods. A guide to best practice  London  BMJ Books

    Burnard P, Morrison P 1994 Nursing research in action  Basingstoke  Palgrave Macmillan

    Cronin P, Ryan R, Coughlan M 2008 Undertaking a literature review: a step-by-step approach  British Journal of Nursing  Vol 17  (1)  pp 38 – 43

    Department of Health 1997 The New NHS London  DH

    Department of Health 2001  A Framework for Lifelong Learning for the NHS London  DH

    Department of Health 2010 Essence of Care London DH

    Ead H 2004  Post-anesthesia tracheal extubation. Canadian Association of Critical Care Nurses 15 (3), pp 20-25

    Farlex Inc. 2011 Medical Dictionary. The free dictionary  [online] The Free Dictionary Available: http://medical-dictionary.thefreedictionary.com/artificial+airway  [11/5/11]

    Gray JAM  2001  Evidence Based Health Care: How to Make Health Policy and Management Decisions  2nd Ed.  London  Churchill Livingstone

    Health Professional Council (HPC) 2008 Standards of conduct, performance & ethics London HPC

    Karmarkar S, Varshney S  2008 Tracheal Extubation  British Journal of Anaesthesia: Continuing Education in Anaesthesia, Critical Care and Pain  Vol 8 (6) pp 214 – 220

    Nursing and Midwifery Council (NMC) 2008 The code: Standards of conduct, performance and ethics for nurses and midwives  London NMC

    Page D 2008 Systematic Literature Searching and the Bibliographic Database Haystack The Electronic Journal of Business Research Methods  6  (2)  pp 171 - 180

    Rassam S, Sandbythomas M, Vaughan RS, Hall JE  2005  Airway management before, during and after extubation: a survey of practice in the United Kingdom and Ireland. Anaesthesia  60 (10)  pp 995-1001

    Schultheis H 1989 When and how to extubate in the recovery room  American Journal of Nursing  89  (8)  pp 1040-1047


    --------------------------------------------------------------------------------------------------


    About the author


    Sarah Dawkins


    I qualified in 2001 and have worked predominantly within the Cardio-Thoracic specialty both on the Wards and in Recovery, in the UK and the USA.  I have, to date, published three articles, with a fourth in the wings, as well as presented my PACU/Nurse led extubation work three times in different venues.  I am always looking for ways to enhance patient care and am an advocate to patients too.

    My MSc is almost complete and I have also undertaken a teaching certificate. I love to learn and share knowledge and imparting it is helping me to grow and learn as well as others.


    Contact details:

    Website:   www.sarahdawkinshealthconsultancy.com

    LinkedIn:  uk.linkedin.com/in/sarahdawkins/

  • 10 Feb 2013 12:29 AM | Anonymous member


    Ambulance Services Benevolent Fund

    is planning for the future




    AMBULANCE SERVICES BENEVOLENT FUND IS PLANNING FOR THE FUTURE.

     “The aim of the ASBF is to be more in line with the support currently offered to members of the Fire, Police and Military charities” explained  Paul Leopold, ASBF Chairman.

    He said: “The next steps for the ASBF is to prepare for the next 25 years and build upon the base support and funding currently provided and available.”

    Paul went on to confirm: “Currently income to provide support for the work of the Charity is donated through salary schemes like Give As You Earn, specific fund raising events, general donations, and recently legacies. We are also indebted to the generous support of Ambulance service magazines and journals and the support from ambulance suppliers such as KL Kerry London who during 2012 promised to donate a percentage of every confirmed order to the ASBF and we were delighted to have received a generous cheque from them.”

    He continued: “To undertake our aims and objectives there our important issues to be addressed from current methods of operation to a more professional and business approach. The intension is for the ASBF to be implementing its vision for the future early this year with an announcement about developments and ‘Caring for the Carers’ programmes.”

    Finally Paul said: “Meanwhile fund raising must continue and to help with this we need the support of the Ambulance Services and their staff NOW. We are actively asking people to become ASBF Champions and promote awareness about the charity to their colleagues and to encourage them to undertake the challenges of fund raising for us. We are always pleased to hear from members of the ambulance services because with your involvement we will together make all the difference”! 


    For further information please visit:

    www.asbf.co.uk Or email: enquiries@asbf.co.uk         


  • 09 Feb 2013 7:58 PM | Anonymous member


         Carbon Monoxide Awareness







    Carbon Monoxide Home Safety Leaflet.pdf

    Carbon Monoxide poster.pdf


    “We’re needed more than ever before” says under-threat charity in pleas for funding 

    Government spending cuts are putting increasing numbers of people at risk of carbon monoxide poisoning, according to the president of a charity that is itself facing closure unless new sources of funding are found.

    Lynn Griffiths, President of Carbon Monoxide Awareness, the charity that established Carbon Monoxide Awareness Week and made it a key feature of the Public Health calendar, says that thousands of people are failing to have gas and other fossil fuel appliances regularly serviced.

    “The simple fact of the matter is that the current economic climate is forcing thousands of people into poverty and they don’t have spare cash for even essential maintenance, like having their central heating boilers and other fuel burning appliances serviced at the appropriate time,” she said.

    “It’s a false economy and people are gambling with their lives, but when it comes down to a choice between putting food on the table and having a flue checked or an appliance serviced. I can understand where they’re coming from. These are desperate days and people are making desperate choices.”

    Approximately 4,000 people are diagnosed with low level carbon monoxide poisoning each year and that figure is just the tip of an iceberg because many cases go undetected. Around 200 are admitted to hospital annually and 50 people die.

    Lynn knows all about the devastating effects of CO poisoning. She and her family were exposed to the deadly gas in their home for many because the gas registered engineers who regularly serviced her gas fire and central heating system failed to spot that a flue was partially blocked.

    “My family’s experience is becoming increasingly common as more people are forced into low-paid employment and cut back on maintenance in the home. Our charity is needed more than ever, but we are under threat because many of our supporters have had their budgets cut and can no longer afford to contribute to charitable causes,” she said.

    Carbon Monoxide Awareness has received some funding from United Utilities and Plus Dane, a Cheshire-based housing association, and a group of APICS chimney sweeps has established a website link through which donors can make their contributions. The link is: www.everyclick.com/carbon-monoxide-awareness-limited/1125755/0/info 

    However, Lynn Griffiths says that more is needed or the charity will be forced to close its doors for good. Leaving those poisoned by this silent killer with nowhere to go for support.  “If 100 businesses,  housing associations or councils were each to contribute £500, which is just £10 a week, the charity can be saved.”


    ------------------------------------------------------------------------------


    The charity’s “National Carbon Monoxide Awareness Week” is launched from the House of Lords every year. The charity travels to Northern Ireland, Scotland and Wales during their Carbon Monoxide Awareness week. Their Home coming event is usually held in the Northwest as this is where the charity was founded in 2005.

    Carbon monoxide (CO) is the most common poison in the UK. Early symptoms are similar to common ailments such as food poisoning, viral infections, flu or simple tiredness. These may include headache, drowsiness, nausea and vomiting, aching muscles, difficulty breathing, vision changes, high blood pressure, tinnitus, rapid pulse, dizziness, vertigo and pins and needles.

    Judgement is impaired and the victim may go through emotional changes and become confused and clumsy. If unchecked and the victim doesn’t leave the toxic environment, loss of consciousness, coma and death may follow.

    Carbon Monoxide Awareness has been run successfully for over seven years by unpaid volunteers who want to make a difference by supporting victims of this silent but deadly potential killer, whilst at the same time working hard to prevent others from becoming victims.

    The charity has produced a carbon monoxide DVD to help raise awareness "formed both a medical and a community group, to pass on to those who join any and all newly discovered information about the effects, treatment or other relevant information on carbon monoxide poisoning" Has developed a useful CO mobile phone App which can be downloaded free of charge from the charity’s website: www.covictim.org

    • Carbon Monoxide is an odourless, colourless gas known as the silent killer. 
    • All gas, oil, coal and wood burning appliances should be serviced every year. 
    • If you are homeowner over pension age, disabled, chronically sick and receiving pension credit or council tax benefit or housing benefit, you can probably get a free Gas Safety check from your gas supplier. See the back of your gas bill or visit your gas supplier’s website for more info.
    • If your home is rented then your landlord must provide a Gas Safety check every 12months.
    • A chimney if you have one should be swept once or twice a year.
    • Carbon Monoxide alarms when fitted need to be sited correctly and in-date. 


    Achievements

    • Established their National Carbon Monoxide Awareness Week
    • The charity offers  support to those poisoned by Carbon Monoxide any time day or night
    • Won the "Plain English Speaking Award" for their Carbon Monoxide leaflet
    • Lobbied for resources to be provided for the education of doctors and nurses in the detection of carbon monoxide related illnesses.
    • Has their contact details listed with NHS Direct and The College of Emergency Medicine. 
    • Held stands at both the Emergency Services and Ambition shows. 
    • Launched its Carbon Monoxide Awareness Healthcare Group in the House of Lords. 
    • Developed a triage poster for hospital A & E departments with the HPA and other partners. This has gone out to every A&E, Minor Injury Units and Walk in Centres.
    • Given talks to fire and rescue, coroners, landlords, and support groups on the dangers of CO. 
    • Helped NPIS update the TOXBASE entry for Carbon Monoxide.
    • Launch a "FREE" Carbon Monoxide Phone App. See www.covictim.org
    • Working with the Chief Fire Officers Association (CFOA) on awareness-raising initiatives.  See: www.cfoa.org.uk/12803  
    • Launched its “Cozy but Deadly Barbecue Campaign” a joint project with Cornwall Fire and Rescue from the House of Commons. This national campaign is believed to of reached millions of people last year.
    • Run press campaigns in partnership with the Health Protection Agency and may others


    For further information please contact 

    Lynn Griffiths. Charity’s founder/founder of Carbon Monoxide Awareness Week

    Victim of carbon monoxide for over a decade 

    Mob 07715899296 

    Email Lynn@covictim.org

    Website: www.co-awareness.org and www.covictim.org  



    Issued by

    Carbon Monoxide Awareness (Charity)

    Charity No. 1125755

    Aintree Community Fire Station, 

    Longmoor Lane, 

    Aintree, 

    Liverpool

    L9 0EN   

  • 08 Feb 2013 2:49 PM | Anonymous member


    ADASS join key sector partners

    in supporting the

    Great British Care Shows





    News Release

    31/01/2013

    ADASS join key sector partners in supporting the Great British Care Shows

    We are delighted to announce that the Association of Directors of Adult Social Services have once again formally endorsed the Great British Care Shows.  

    The shows are also supported by Ceretas, the English Community Care Association and Carers UK and will provide a unique networking opportunity, linking in with local commissioners, local care association and local service users and are set to be a significant date for the calendar in these regions.

    Sarah Pickup, President for ADASS said,

    "ADASS welcomes plans to run Great British Care shows. It is more important than ever that all of those involved in the commissioning and delivery of care learn from each other and that we take every opportunity to support the workforce to deliver quality care and maintain dignity. 

    “The shows will allow people who have won awards for their own excellent practice to share their approach in more detail with others. The proposed format of the shows means that they should support our objective of making information and advice about care and support more readily available. 

    “There should also be opportunities for providers and commissioners to engage in considering the types of services we need to develop and the different ways in which these could be commissioned."

    Alex Shepherd, Events Manager for the Great British Care Shows said,

    "We are delighted that ADASS are officially endorsing these significant events.  These care shows are not a trade show and are very much a local forum for local people.  The delegate programme will be about showcasing local resources, a platform for seeking advice about issues that face service users in the community as well as for providers, commissioners and professionals from the private residential and domiciliary care sectors.  The shows are set to become a important event in the social care calendar and the support from these key sector partners is extremely significant."

    For more exhibitor information please click here

    For delegate inquiries please click here

    Lets' showcase excellence in social care and help it get the recognition it deserves


    • For more information, dates and venues for the 2013 Great British Care Shows visit www.gbcareshows.co.uk
    • For more information on the Association of Directors of Adult Social Services visit www.adass.org.uk
  • 08 Feb 2013 2:45 PM | Anonymous member


    The Alzheimer's Society support the

    Great British Care Shows 






    News Release 

    25/01/2013

    The Alzheimer's Society support the Great British Care Shows 

    We are delighted to announce that the Alzheimer's Society are supporting the Great British Care Shows together with the Great British Care Awards and will be exhibiting at each of the forthcoming 9 regional events in 2013. 

    The Alzheimer's Society is a membership organisation which works to improve the quality of life of people affected by dementia in England, Wales and Northern Ireland.  Many of their 20,000 members have personal experience of dementia as health professionals, carers or people with dementia themselves; their experiences really help to inform our work.

    The Great British Care Shows, in association with the Alzheimer’s Show, will showcase the very best products, services and information as well as providing practical help and solutions for people living and working with dementia.

    The events have received backing from key sector bodies including the Association of Directors of Adult Social Services, (ADASS), Carers UK, the English Community Care Association (ECCA) and Ceretas.

    The format of the show will include presentations from dementia organisations and individual dementia specialists.  Delegates will include local authority commissioners, care providers, care professionals and unpaid carers - most of who will be seeking information and innovative ways on improving care provision for people suffering from dementia.

    Kathryn Smith, Director of Operations, Alzheimer's Society said,

    "Alzheimer’s Society is pleased to support the care shows and care awards in 2013. These key events provide an important opportunity to meet with people across the care industry who are working to support thousands of people with dementia and their families, and to help raise excellence in social care." 

    For more information visit www.gbcareshows.co.uk

    Lets' showcase excellence in social care and help it get the recognition it deserves


    • For more information, dates and venues for the 2013 Great British Care Shows visit www.gbcareshows.co.uk
    • For information about the Alzheimer's Society visit www.alzheimers.org.uk





  • 08 Feb 2013 11:00 AM | Anonymous member


       Count down to the 2013

       Great British Care Shows

       begins





    News Release

    18/01/2013

    Count down to the 2013 Great British Care Shows begins

    Following on from the success of last year's two pilot events, the 2013 series of the Great British Care Shows are rapidly taking shape featuring in nine regions across the country starting in March this year.  The shows, which are sponsored by the Royal Bank of Scotland and being held in association with the Alzheimer's Show, are quickly taking momentum with exhibitors and delegates already registering their support.

    The shows are also supported by Ceretas, the English Community Care Association and Carers UK as well as having received wide interest from across the social care sector.

    The Great British Care Shows have developed an innovative approach to move away from the usual road show and create a new and exciting programme for exhibitors and delegates:

             Local care shows

             Practical solutions for achieving outcomes and excellence

             Industry expert sessions

             Question time debating the policy agenda and the future of the market

             A unique networking opportunity

             One to one expert discussion sessions for solutions for excellence

             A display of all the latest products and services

    Delegates will stem from all areas of the sector such as private, statutory, and voluntary and will include Commissioners, Directors of adult social services, care providers, owners, managers, care workers, unpaid carers and service users from the community.

    Speakers include representatives from the Department of Health, the Social Care Institute for Excellence, the National Skills Academy for Social Care, the English Community Care Association, Care Quality Commission and Skills for Care.  Sector experts in the area of dementia, end of life care, training and development, nutrition, health and safety will also be presenting.

    In addition to the keynote sessions there will be a number of ‘Light Bulb’ sessions; quick, lively and innovative presentations throughout the day.   These ‘Light Bulb’ sessions will be aimed at achieving a fast track to excellence and based around the categories and good practice examples gleaned from the Great British Care awards.

    The shows will provide a unique networking opportunity, linking in with local commissioners, local care association and local service users and are set to be a significant date for the calendar in these regions.

    Entry to the show is free and delegates can register online at www.gbcareshows.co.uk

    Last year's feedback will give this year's delegates a flavour of what to expect, 

    “A really enjoyable and informative day and a great opportunity to network. Can't wait for the next one”

    Mary Bryce, speaker and chair of Ceretas 

    "The light bulb sessions and talks that I managed to fit in were equally as interesting and informative. My only complaint is I couldn’t manage to fit more in.  Many thanks to the organisers, exhibitors, speakers and those running the seminars it was a wonderful success and I look forward to the next one.”

    John Ireland - delegate and team Leader, Millers

     “The Great British Care show was a great opportunity to both hear some of the latest thinking on the future of the sector and to network with key suppliers and agencies.  It was great to have an event of this nature locally"

    Mark Greaves, managing Director, Ideal Care Homes

    For more information or to register as a delegate visit www.gbcareshows.co.uk

    Lets' showcase excellence in social care and help it get the recognition it deserves

     

     For more information, dates and venues for the 2013 Great British Care Shows visit www.gbcareshows.co.uk



  • 05 Feb 2013 10:07 PM | Anonymous member

    Use of the Automated External Defibrillator (AED)
    within the Dental Practice

    by

    Wendy Berridge






    WHY IS AN AED SO IMPORTANT?  (“In the UK approximately 30,000 people sustain cardiac arrest outside hospital and are treated by the emergency medical services (EMS) each year. Electrical defibrillation is well established as the only effective therapy for cardiac arrest caused by ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). The scientific evidence to support early defibrillation is overwhelming; the delay from collapse to delivery of the first shock is the single most important determinant of survival. If defibrillation is delivered promptly, survival rates as high as 75% have been reported. The chances of successful defibrillation decline at a rate of about 10% with each minute of delay, basic life support will help to maintain a shockable rhythm but is not a definitive treatment. The Resuscitation Council (UK) recommends strongly a policy of attempting defibrillation with the minimum of delay in victims of VF/VT cardiac arrest.”)                                     Resuscitation Council (UK) 2012.


    CARDIAC ARREST  The most common cause for the heart to stop (cardiac arrest) is a “heart attack”, though it is worth noting that a heart attack does not always cause a cardiac arrest. The majority of people who suffer a heart attack stay conscious and survive. “Sudden Cardiac Arrest” (SCA) however, is as its name implies - it can happen at any time -  and can affect anyone, even if they are young and seemingly fit.

    If a heart attack (or other cause) results in a cardiac arrest, it is usually because it has interrupted the heart’s own electrical impulses, and this causes the heart to act chaotically (VF or VT) instead of beating in a co-ordinated rhythm.


                                       Chain of survival


    If a casualty suffers a cardiac arrest, there is a sequence of events that must happen in order for them to stand a chance of survival. This is known as the “Chain of Survival”

    1 Early recognition and call for help.                                                                                                                  Help must be summoned immediately so that the other links in the chain of survival can happen. In the case of a heart attack most casualties look and feel ill for a while, so it is important to call for help if you think a person might have a cardiac arrest so that help can arrive before they collapse. Ideally, send someone else to call for the EMS and tell them to come back as soon as possible. If no-one is available then make the call yourself and tell them you are alone and about to start CPR.

    2 Early CPR.                                                                                                                                                  The purpose of early CPR is to buy time for the casualty. Chest compressions are needed to push blood around the body and inflations using high-flow oxygen via the Bag Valve Mask (BVM) are needed to put more oxygen in. Early CPR has been proven to more than double the chances of survival. Effective CPR with the use of oxygen increases the chance of successful defibrillation.

    3 Early defibrillation.  Remember – defibrillation is the only effective treatment for a casualty in cardiac arrest caused by VF or VT, and for every minute it takes to administer the first shock the chance of survival reduces by as much as 10%. Therefore the most important determinant to survival is the delay from collapse to delivery of the first shock.

    4 Early advanced care.  Early advanced care from professional medical personnel is essential to stabilise the casualty and increase their chance of survival.


    THE HEART  The heart is a cone shaped hollow muscular organ, and is the only muscle in the body that can create its own electrical impulses.

    The two top chambers of the heart (atria) collect blood from the two largest veins in the body and squeeze it into the chambers below (ventricles). The heart has its own primary pacemaker, situated at the top right hand side, which fires electrical impulses through the atria first, making them contract. They then pass through the ventricles, causing them to contract next, which pumps the blood out of the heart. The electrical cells then “recharge” ready for the next wave of electricity.                                                                          

    HEART RHYTHMS  The AED will analyse the heart’s rhythm, which is likely to be in one of four, listed below:   

    Normal (normal sinus rhythm)

    Ventricular fibrillation (VF)

    Ventricular tachycardia (VT)

    No activity (asystole)


    In the above reading (asystole) the heart is still. There is no electrical activity at all and occurs after the heart has eventually run out of oxygen. This is commonly referred to as “flatline” and is classed as a “non-shockable rhythm”. The AED can no longer deliver a shock because the heart is now “stopped”.

    Therefore, the AED can only work if the heart is in a “shockable rhythm”. Contrary to what many believe, the defibrillation shock does not “jump start” a heart once it has stopped. The shock is designed to make the heart’s electrical cells re-charge, which can stop the fibrillation and brings the heart to a standstill. Once fibrillation is stopped, the heart’s own pacemaker should start to send normal impulses once again. Maybe the best way of describing it is as similar to “rebooting” a computer.

    When someone suffers a heart attack, an area of the heart loses its blood supply and dies as a result. However, while this is happening, the dying area becomes very unstable and can send its own electrical impulses, and these “mis-fires” interrupt the normal electrical activity of the heart, causing it to beat too rapidly (ventricular tachycardia), irregularly (ventricular fibrillation) or both. This can result in the whole electrical system becoming disrupted. Instead of beating in a co-ordinated rhythm, the electrical cells start firing independently, stopping the heart from pumping blood effectively. Some cardiac arrests are due to extreme slowing of the heart. This is called bradycardia.

    Other factors besides heart disease and heart attack can cause cardiac arrest. They include respiratory arrest, electrocution, drowning, choking and trauma. Sudden cardiac arrest can also occur without any known cause. 

    Remember, there are two common misconceptions about the use of defibrillators: 

    “A defibrillator starts the heart beating again once it stops”

    The  defibrillator actually stops the heart during fibrillation so that the heart can restore a normal rhythm. CPR can help to maintain a “shockable rhythm” for as long as possible, however, the longer the defibrillator takes to arrive, the more likely the heart will have become asystolic (a non-shockable rhythm.) A “flatline” is the common name for an asystolic rhythm, so cannot be shocked. The chance of survival is as high as 75% if the first shock can be delivered within the first 3-5 minutes. However, after this time the survival rate drops by approximately 10% per minute.

    2   “There is a risk that the defibrillator will shock a heart that is beating normally, and cause it to stop”

    A normally beating heart (normal sinus rhythm) is also a non-shockable rhythm. Therefore the defibrillator will not administer a shock if attached to a casualty whose heart is still beating with a normal rhythm.

    WHO CAN USE AN AED?  The Resuscitation Council (UK) recommends that “All healthcare professionals should consider the use of an AED to be an integral component of BLS. Untrained employees working in healthcare establishments should not be prevented from using an AED if they are confronted with a patient in cardiac arrest. The administration of a defibrillatory shock should not be delayed while waiting for a more highly trained personnel to arrive.”                                                                                                                                               

    “An AED can be used safely and effectively without previous training. Therefore, the use of an AED should not be restricted to trained rescuers. However, training should be encouraged to help improve the time to shock delivery and correct pad placement.” The Resuscitation Council (UK) also recommends that an AED be made available wherever crowds gather, for example at sports stadiums, theatres, cinemas, shopping centres, airports, train and bus stations etc.

    REMEMBER: 

    • The frequency of cardiac arrest is such that there is a reasonable probability of the use of an AED at least once in five years.
    • The time from call out of the EMS to delivery of first shock cannot be achieved within 5 minutes (most of UK).
    • The time from collapse of a casualty until on-site AED is used should be within 5 minutes.
    • The Resuscitation Council (UK) recommends that if a defibrillator is present, use IMMEDIATELY (do not wait to use an AED whilst CPR is carried out).

    TYPES OF AUTOMATED EXTERNAL DEFIBRILLATOR  “AEDs are sophisticated, reliable, safe, computerised devices that deliver electric shocks to victims of cardiac arrest when the ECG rhythm is one that is likely to respond to a shock. Simplicity of operation is a key feature: controls are kept to a minimum, voice and visual prompts guide rescuers. Modern AEDs are suitable for use by both lay rescuers and healthcare professionals”

    All AEDs analyse the victim’s ECG rhythm and determine the need for a shock. The semi-automatic AED indicates the need for a shock, which is delivered by the operator, while the fully automatic AED administers the shock without the need for intervention by the operator.” R C (UK) 2012.   

    Although AEDs are designed to do the same thing, they can be very different in design, colour, size, number of buttons and use of voice prompt language. It is essential, therefore, that you are familiar with the particular unit you may have within your practice. If you are considering obtaining an AED, the following may be useful when making a decision as to which to have within your practice.

    • Buttons   While some AEDs only have one button that will deliver the shock, some units can have up to three buttons;
    1. One to turn the unit on
    2. One to analyse the rhythm
    3. One to deliver the shock
    • Size   AEDs are about the size of a small laptop computer and can weigh approx 2 kilos. Units have either a carrying handle attached or come in a carry case which is a handy place to keep spare electrodes, battery packs and rescue ready packs (see below)
    • Electrodes   These are stored with the AED and are wrapped in foil. Some AEDs have the electrodes already attached whilst others are separate and need connecting once the AED is switched on. (There will be a voice command to tell you when and where to attach the lead). The electrodes have a shelf life of approx 2 years.
    • Battery   Most AEDs have one large lithium battery pack which needs replacing every 2-7 years depending on the unit. Some use standard camera batteries which are cheaper to replace.
    • Status Indicator   Most AEDs have some form of status indicator which shows that the machine is ready for use. AEDs perform a variety of daily, weekly and monthly self-checks to ensure battery levels are OK, that electrodes are attached properly, that software isn’t malfunctioning and whether a service is due or not. The AED will flash or beep to indicate that a fault has been located. It is vital, therefore, that staff understand the need to ensure that their AED is ready at all times.


    RESCUE PACK  It is advisable to carry the following accessories with the AED;

    • Scissors   You will probably need to cut open clothing to expose the bare chest. It’s therefore advisable to have a strong pair that are capable of cutting through thick material, such as “tough cut” safety scissors.
    • Razor   A good quality disposable razor is useful to remove any excessive chest hair where the pads need to be applied to ensure that they stick closely to the skin.
    • Small towel/flannel   It is common for a casualty suffering a heart attack to sweat profusely and the chest must be dry to ensure a secure adhesion of the pads.

    It is also recommended that you also include the following:

    • Spare AED pads   If a pad gets torn, or fails to stick properly, then having spare pads available will save time.
    • Paediatric pads   Most machines require paediatric pads to be connected if using the AED on a child (1-8 years).
    • Protective gloves   Always wear protective gloves when dealing with the casualty.

    AED SAFETY CONSIDERATIONS

    • Jewellery   Take care not to place pads over jewellery such as a necklace. This would conduct the electricity and burn the casualty. There is no need to remove piercings, but ensure that pads are not placed over them.
    • Medication patches   Some heart patients wear a “glyceryl tri-nitrate” (GTN) patch which may explode if electricity is passed through it, so remove ALL visible medication patches as a precaution.
    • Implanted devices   Some heart patients may have a pacemaker or defibrillator implanted. These can usually be seen or felt just below the left collar bone, which is not in the way of the pads and care must be taken not to place the pads over them.
    • Supplemental oxygen   There are no reports of fires caused by sparking where defibrillation was delivered using adhesive pads. If oxygen is being delivered by a face mask, remove the mask and place it at least one metre away before delivering the shock. Do not allow this to delay shock delivery.
    • Defibrillation if the victim is wet   As long as there is no direct contact between the user and the victim when the shock is delivered, there is no direct pathway that the electricity can take that would cause the user to experience a shock. Recent tests have shown that the risk of accidental shock is low, because the electricity only wants to travel from one pad to another, not to “earth” like mains electricity. Do not delay defibrillation because the casualty is on a wet, or metal surface – providing the chest is dry it is safe to deliver the shock.
    • Inappropriate shock   The casualty needs to be motionless to analyse rhythms. Do not use on a casualty who is fitting (violent jerking movements) and ensure vibrating machinery is switched off whenever possible.

    OTHER CONSIDERATIONS  

    • Pad positioning   Recent studies have found that the position of the pad on the lower left chest can affect the effectiveness of the shock. Ensure the pad is placed around the side of the chest and not on the front. This ensures the maximum electricity flows through the heart rather than across the chest surface. Most AEDs will inform the rescuer if the pads are incorrectly positioned, however, training will ensure that all staff know exactly where they should go. Although most AED pads are labelled left and right, or carry a picture of their correct placement, it does not matter if their positions are reversed. It is important for staff to understand that if this happens “in error” the pads should not be removed and replaced as this wastes time and they may not adhere adequately when re-attached.
    • CPR before defibrillation   Provide good quality CPR while the AED is brought to the scene. Continue CPR whilst the machine is turned on, then follow the voice and visual prompts. Giving a specified period of CPR, as a routine before rhythm analysis and shock delivery, is not recommended. If you are on your own, ring for the EMS first, and then fetch the AED, switch it on and apply pads, even if this means delaying the onset of CPR, as the first shock should be delivered within 3-5 minutes, if possible.
    • Minimise interruptions in CPR   The importance of early, uninterrupted chest compressions is emphasised throughout the Resuscitation Council (UK) guidelines. Interrupt CPR only when it is necessary to analyse the rhythm and deliver a shock. When more than one rescuer is present, the rescuer operating the AED applies the electrodes while the other(s) continue CPR. The AED operator delivers a shock as soon as the shock is advised, ensuring that no-one is in contact with the casualty.

    STORAGE AND USE OF AEDS  “AEDs should be stored in locations that are immediately accessible to rescuers; they should not be stored in locked cabinets as this may delay deployment. Use of the UK standardised AED sign (see below) is encouraged, to highlight the location of an AED. People with no previous training have used AEDs safely and effectively. While it is highly desirable that those who may be called upon to use an AED should be trained in their use, and keep their skills up to date, circumstances can dictate that if no trained operator (or a trained operator whose certificate of training has expired) is present at the site of an emergency no inhibitions should be placed on any person willing to use an AED”    RC (UK) 2012.

    PUBLIC ACCESS DEFIBRILLATION (PAD)  “Public access defibrillation is the term used to describe the use of AEDs by laypeople. Two strategies are used. Firstly. AEDs are installed in public places and used by people nearby. Impressive results have been reported with survival rates as high as 74% with fast response times often possible when an AED is nearby. The second strategy uses first responders despatched by an ambulance control centre when they may reach a patient quicker than a conventional ambulance” RC(UK) 2012

    RESUSCITATION WITH THE USE OF AN AED

    DANGER

    • Make sure that the casualty, any bystanders, and you are safe

    CHECK FOR RESPONSE

    • If there is no response, shout for help immediately

    AIRWAY

    • Carefully open the airway by using “head tilt” and “chin lift”

    BREATHING

    • Keeping the airway open, look, listen and feel to see if the breathing is “normal”.  Take no more than 10 seconds to do this
    • If the casualty is breathing “normally” place them into the recovery position


    IF THE CASUALTY IS NOT BREATHING NORMALLY:

    • If you are on your own, call for EMS (emergency services) AND GET THE AED
    • If you have help – start CPR immediately whilst your helper(s) call for EMS and get the AED. If there is anyone else available send them for the oxygen and breathing apparatus

    CONTINUE CPR USING RATIO OF 30 COMPRESSIONS TO 2 INFLATIONS UNTIL THE AED ARRIVES

    AS SOON AS THE AED ARRIVES:

    • Continue CPR if more than one rescuer present
    • Switch on the AED immediately and follow the voice prompts:
    • Attach the leads to the AED if necessary and attach the pads to the casualty’s bare chest after cutting through clothing, doing this whilst the other rescuer(s) continue CPR if possible (remember – every minute counts)
    • You may need to towel dry or shave the chest so that the pads stick properly. Only shave excessive hair over where the pads are to be positioned and don’t delay defibrillation if a razor is not available
    • To place the pads, peel one pad from the plastic backing and place it to the right of the sternum (breast bone) just below the casualty’s right clavicle (collarbone) as shown on the pad
    • Peel the second pad from the backing and place on the lower chest wall on the left, just below the apex of the heart, as shown on the pad  DO NOT REMOVE THE PADS IF YOU HAVE PLACED THEM THE WRONG WAY ROUND – THE AED WILL STILL WORK
    • Whilst the AED analyses the rhythm – stop CPR and ensure that no-one is touching the casualty by shouting “STOP CPR”. YOU WILL NOT GET A SHOCK AT THIS POINT – HOWEVER, THE AED CANNOT SUCCESSFULLY DETERMINE THE RHYTHM IF THE CASUALTY IS MOVING. IF YOU ARE STILL TOUCHING THE CASUALTY THE AED MAY DETECT YOUR OWN RHYTHM ALSO AND THIS WILL CAUSE A DELAY

    IF A SHOCK IS ADVISED:

    • Ensure that nobody touches the casualty. The AED will take a few seconds to fully charge. Shout “STAY CLEAR”
    • Once the AED advises you to press the button to deliver the shock check the casualty from head to toe to ensure everyone is clear, shout “SHOCKING NOW” and press the shock button. REMEMBER THAT A FULLY AUTOMATIC AED WILL DELIVER THE SHOCK WITHOUT THE NEED TO PRESS A BUTTON SO BE CLEAR IN YOUR INSTRUCTIONS TO OTHER RESCUERS
    • Continue as directed by the voice/visual prompts
    • Minimise, as far as possible, interruptions to chest compressions

    IF A SHOCK IS NOT ADVISED:

    • Immediately resume CPR using the ratio of 30 compressions to 2 inflations
    • Continue as directed by the voice/visual prompts

    CONTINUE TO FOLLOW THE AED PROMPTS UNTIL:

    • Qualified help arrives and takes over OR
    • The casualty starts to show signs of regaining consciousness, such as coughing, opening the eyes, speaking, or moving purposefully AND starts to breath normally OR
    • You become exhausted

    ALWAYS LEAVE THE ELECTRODE PADS ON THE CASUALTY EVEN IF THEY APPEAR TO HAVE RECOVERED AS THEIR CONDITION MAY QUICKLY DETERIORATE

    • The instructions above follow the latest Resuscitation Council (UK) guidelines published in October 2010. Some older AEDs (pre 2006) may use older guidelines. If you have an AED that you think may be pre 2006 check with your AED supplier if an update is available. If your AED follows older guidelines it is still acceptable to use it (following the voice prompts, as stated above) as defibrillation using older guidelines is better than no defibrillation at all.

                                                                                                   


    CORRECT PLACEMENT OF ELECTRODE PADS ON AN ADULT                       



    UK STANDARDISED AED SIGN



    Wendy Berridge delivers CPR, Medical Emergencies and AED training to dental practices throughout Yorkshire and Lincolnshire.



    Contact details:

    tel: 07771590513

    email: info@berridgemedicaltraining.com

    Website: www.berridgemedicaltraining.com

  • 05 Feb 2013 5:26 PM | Anonymous member (Administrator)

    FREE Membership for Team Leaders
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  • 04 Feb 2013 9:45 PM | Anonymous member


    Mountain Trauma Rescue Services hosting

    first Prehospital Trauma Symposium in Cumbria



    On the 22-24 February Mountain Trauma Rescue Services will be hosting the first Prehospital Trauma Symposium in Ambleside, Cumbria.

    This event will consist of a range of presentations and practical workshops, delivered by experts in their subjects. Friday's theme will be remote trauma and rescue, Saturday will focus on major incidents and Sunday will focus on major trauma.

    The Symposium is open and relevant to anyone who is responsible for providing trauma care in a prehospital setting from doctors and paramedics to volunteer rescue services. In addition to learning more about the latest trauma research delegates will learn how multi-agencies deal with trauma victims and will it will also give those who attend a great networking opportunity.

    A full programme and descriptions of speakers can be found at www.traumasymposium.co.uk. College of Paramedics and Mountain Rescue Teams are entitled to 30% discount on delegate costs. Prices start at £30 before any discounts!

    This is a fantastic, interactive CPD opportunity set within the beautiful Lake District. We hope you can join us.

  • 03 Feb 2013 9:56 PM | Anonymous member

                

      First Intervention Ghana

      Appeal for Ambulance and Capacity Building






    APPEAL FOR AMBULANCE AND CAPACITY BUILDING

    Injury accounts for 16% of the global burden of disease. As one of the leading causes of mortality and morbidity worldwide, it overwhelmingly affects low and middle income countries of which Ghana is no exception. Evidence has shown that deaths are prevented and disability averted for conditions such as trauma, pregnancy, myocardial infarction, stroke and sepsis by upgrading the emergency services.


    Pre-hospital care research in Ghana has, to a large extent, focused on trauma. Mortality from severe injury occurs in one of the following three phases:
    1) Immediate phase occurs as a result of overwhelming injury
    2) Intermediate or sub-acute phase involves deaths occurring within several hours of the event and are potentially treatable.
    3) Delayed phase when deaths often occur days or weeks after the initial injury.

    The general understanding is that patients have better disease outcome if provided with definitive care within 60 minutes of the occurrence of injuries. Hence, pre-hospital care is most beneficial during the second phase of the conditions such as trauma. 

    This timely provision of care can limit or halt the cascade of events that otherwise rapidly lead to death or lifelong disability. Without standard pre-hospital care, people with good survival possibilities also die at the scene or en route to the hospital. Most deaths in the early hours after injury are the result of airway compromise, respiratory failure or uncontrolled haemorrhage. All three of these conditions can be readily managed using basic first aid measures.

    Emergency Medical Services (EMS) constitute both pre-hospital and hospital services. Both have long been neglected in many countries of the developing world. In Ghana, Patients are instead brought to the Casualties/Emergency Departments (ED) by relatives or bystanders in private cars, taxis or any other readily available mode of transportation. The Patients commuting to major cities from remote areas are most vulnerable. They often do not have any means of transportation and have to travel on foot without any first aid. Patients referred to hospitals seek private cars and taxis as mode of transportation. 

    Certain situations in life require convenient and safe mode of transportation (ambulance) and a fraction of a second delay can drastically change somebody's life.

    As part of our strategic plan and our quest to reduce helplessness, mitigate needless fatalities and respond appropriately, an appeal for an Ambulance and other emergency management equipment have been initiated to enable us to acquire an ambulance to equip us with necessary equipment to manage emergencies effectively. 

    We acknowledge your high reputation and kind gesture in times of need over the years, so we would like to have your kind spirit of giving to the service of humanity for our organisational development and support a good course achieved.

    Please do not hesitate to contact us through our addresses below:


    Postal address:

    First Intervention Ghana 

    P.O.Box ct 360

    Cape Coast, Ghana


    Attn: Jonathan Hope||Chief Executive Director


    Email: firstinterventionghana@yahoo.com


    Mobile phone: +233246469484


    Websites: www.firstinterventionghana.org

                  www.firstinterventionghana.de


    Facebook: www.facebook.com/firstinterventionghana

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