New Quality Standards for Primary Dental and Primary General Care
I attended the Advanced Life Support Instructors’ day with The Resuscitation Council (UK) on the 27th November. It was a very enjoyable day. Amongst other things the new quality standards for primary care were announced. They have now been published and can be found in full at http://www.resus.org.uk/pages/QSCPR_Main.htm.
I sent a brief newsletter on the 4th December, but now I’ve had time to digest them fully I wanted to bring your attention to a few points. These standards relate to cardio-respiratory arrest only, therefore be aware that you are still required to have any necessary equipment to deal with other medical emergencies eg anaphylaxis.
I’ve separated my discussion into sections:-
AEDs (Automated External Defibrillators)
The new quality standards for primary care from the RCUK (The Resuscitation Council (UK)) have said that the public expects all healthcare organisations to have an AED available, and that dental premises are no exception. They have said all areas should have immediate access to an AED and immediate is defined as being available in the first minutes of a cardiac arrest i.e. at the start of resuscitation.
To aid clarity they have also defined ‘should’
- The term ‘MUST’ has been used when the consensus is that the standard promotes normal practice and is obligatory.
- The term ‘SHOULD’ has been used when the consensus is that the standard promotes normal practice.
- The term ‘RECOMMENDS’ is used when the consensus is that the standard promotes best practice.”
This means that the final decision is to be based on a local risk assessment but the standard for defibrillation is that it can be achieved within 3 minutes of identifying cardiorespiratory arrest.
So what to do?
If you have an AED or were thinking about purchasing an AED anyway then you’re ahead. If you want advice about purchasing an AED then feel free to get in touch Helen@orchardtrainingservices.co.uk. It is also recommended that if you have an AED that you use the standard AED sign and register your AED with your local ambulance service. The link for the sign is here www.resus.org.uk/pages/AEDsign.htm
If you’re not sure about purchasing an AED then there are a few things to consider. There are alternatives to buying and some organisations such as BOC Healthcare*, whom some of you already have contracts with, will lease AEDs therefore dramatically reducing the initial cost.
In this document the RCUK haven’t discussed the emotional impact on staff who are involved in a resuscitation attempt. I’d like to consider this. I think this is heightened when you are in the community and it is not a common event. If someone collapses then everyone involved ants to feel that they did their best. The research is available to show that early defibrillation improves survival rates. If you don’t have an AED available then should someone collapse on your premises you and your team face the ‘what if?’ question. In comparison if you have an AED available it removes that doubt; more importantly you may save someone’s life, an indescribable feeling for you and your team.
The standards above make it very clear that it as an expectation that healthcare premises including general and dental primary care will have their own AED available and receive training on it. The RCUK is describing what they consider normal practice and public expectation, this is important to give credence to as it is here that lays the judgement of your practice.
If you don’t have an AED available you’ll need to undertake a risk assessment, to keep on file. You may have an AED already in your locality that you may be able to access; therefore as part of your risk assessment I’d recommend that you organise a drill and see if you could deliver a defibrillator shock within 3 minutes, if you would like help with this again please contact me .
If you find you cannot achieve the 3 minute target and remember the delay that may occur due to anxiety and staff being unfamiliar with the procedure then I would strongly recommend that you purchase/lease one based on the standards above. If your drill is successful and you can achieve a shock within 3 minutes then, in my opinion, you’ll need to check regularly and practise with different team members to maintain procedural familiarity. Then the local decision is yours as described by the RCUK. However, their guidance and my opinion is that you should have one on the premises.
With regard to training it seems that even if you don’t have an AED you do need to have the training.
The RCUK have said that
- Primary dental care providers, general dental practitioners and all other dental healthcare professionals should undergo training in cardiopulmonary resuscitation (CPR) including basic airway management and the use of an AED.
And for general practice have said that
- as a minimum all clinical staff can:
- recognise cardiorespiratory arrest;
- summon help;
- start CPR;
- attempt defibrillation (if appropriate) with an automated external defibrillator (AED) with the minimum of delay, whenever possible within 3 minutes of collapse.
Therefore whether or not you have an AED you should be trained in its use. I do try to include a brief awareness session in your training but ideally every session should now include AED training. With the increasing numbers of Public Access Defibrillators (PADS) this is (in my opinion) an essential skill. They really are very easy to use and not like you see on the telly! A good learning tool is the https://life-saver.org.uk/
The RCUK also recommend basic airway management training. I already include basic airway management in my courses and include discussion about oropharyngeal airways. I will enhance this to enable practise inserting an airway in the New Year. The council have also recommended that clinical staff should be assessed so I will build this into the session too and your certificate will reflect this.
It is also documented that staff receive training as part of their induction ~ something I already do for my existing customers so that’s easy to achieve. Also on-going training should be at least annual, this is the standard that the majority of practices already work to so again easily achievable.
The next issue addressed in these standards is the checking of equipment. My customers know my view that equipment is checked not only to ensure it’s available but also to improve familiarity. The RCUK recommend a minimum of weekly checks and that this should be the subject of a local audit. I feel that when new equipment is purchased that this be increased to daily and the role be rotated amongst staff to achieve familiarity.
The RCUK have also recommended that primary care organisations in General Practice should have access to a Resuscitation Officer (RO). This RO will have primary responsibility for
“the coordination of all matters pertaining to resuscitation including training, audit and overseeing equipment.”
They will work with a named resuscitation lead within the individual organisations
“This person should be accountable for adherence to quality standards within their organisation and should ensure that basic tasks such as checking equipment are done routinely.”
They also say
“At least one such clinical trainer should be an Advanced Life Support (ALS) provider (or equivalent) at a minimum and preferably an ALS Instructor or holder of another qualification in teaching/training, so that they can support and train clinicians with extended skill sets and those caring for high-risk patients.”
They also place requirements on the RO to maintain their skill by attending relevant courses/conferences and working in an acute area.
I would like to assure my customers or anyone considering me as their training provider that I am an ALS instructor, that I have a PGDip in Medical Education and that I continue to work clinically in A&E and Minor Injuries. I also regularly attend relevant conferences/courses. I am therefore qualified to act as your RO should you wish to use my services. Please see my about us page.
Please contact me if you would like more details on equipment, training or have any questions regarding these standards.
*COI- I receive a nominal commission from BOC Healthcare for the purchase of an AED by one of my recommendations