This action states

The health service organisation has processes to ensure rapid access at all times to at least one clinician, either on site or in close proximity, who can deliver advanced life support

Intent

Expert input and assistance is available to manage acute physiological deterioration.

Reflective question

What processes are in place to ensure that clinicians who are competent in providing advanced life support are available to respond to patients who acutely deteriorate?

Key task

Provide a system to ensure rapid access to advanced life support for patients who acutely deteriorate.

Strategies for improvement

Hospitals

Ensure that response systems include provision for rapid access to at least one clinician with advanced life support skills at all times. Develop and maintain rosters to enable rapid access to this clinician at all times. In most large health services, this clinician will be accessed through the rapid response system.

Establish clinicians’ competence in advanced life support with evidence of relevant qualifications (for example, advanced life support certification compliant with Australian Resuscitation Council guidelines or medical qualifications in specialties such as anaesthesia and critical care). Establish competence in paediatric advanced life support for responders in services that provide care to children. More clinicians may require training so this level of care can be provided 24 hours a day and when key clinicians are absent.

Clinicians need regular opportunities to practise and maintain their skills so that they retain competence.1,2 Put systems in place to provide evidence of clinicians’ ongoing competence in advanced life support. This may require the organisation to provide access to formal advanced life support training for clinicians. Further benefits can be gained by providing opportunities for members of rapid response teams to train together, and practise using non-technical skills such as leadership, teamwork and communication while managing simulated scenarios of acute deterioration.

Day Procedure Services

Ensure that response systems include provision for rapid access to at least one clinician with advanced life support skills at all times. Depending on the size, location and type of day procedure service, options to provide this access include:

  • Supporting senior nurses to complete advanced life support training
  • Developing agreements with anaesthetists who provide services in the organisation
  • Accessing external ambulance services.

If advanced life support is to be provided by members of the workforce, establish clinicians’ competence in advanced life support with evidence of relevant qualifications (for example, advanced life support certification compliant with Australian Resuscitation Council guidelines or medical qualifications in specialities such as anaesthesia and critical care). Establish competence in paediatric advanced life support for responders in services that provide care to children. More clinicians may require training so that this level of care can be provided when key clinicians are absent.

Clinicians need regular opportunities to practise and maintain their skills so that they retain competence.1,2 Put systems in place to provide evidence of clinicians’ ongoing competence in advanced life support. This may require the organisation to provide access to formal advanced life support training for clinicians. Additional benefits can be gained by providing opportunities for members of rapid response teams to train together, and practise using non-technical skills such as leadership, teamwork and communication while managing simulated scenarios of acute deterioration.

Examples of evidence

Select only examples currently in use:

  • Rosters of clinicians who can provide advanced life support
  • Audit results of episodes requiring advanced life support, to determine whether members of the workforce who can provide advanced life support were available
  • Employment documents that describe advanced life support roles, responsibilities and accountabilities
  • Evidence of qualifications or up-to-date certification for the provision of advanced life support
  • Policy documents for rapidly gaining access to a clinician who can provide advanced life support
  • Records of ongoing competency assessments for advanced life support
  • Training documents about non-technical skills relating to advanced life support, such as teamwork, team leadership and communication.

MPS & Small Hospitals

MPSs and small hospitals should provide a system to ensure rapid access to advanced life support for patients who acutely deteriorate. This includes provision for rapid access to at least one clinician with advanced life support skills at all times. Develop and maintain mechanisms to enable rapid access to this clinician(s) at all times.

Mechanisms may include:

  • Providing extra training to some doctors and nurses to ensure the required level of care can be provided 24 hours a day and when clinicians are absent; external training programs can be used to provide training in advanced life support skills if this cannot be provided locally
  • Establishing competency in paediatric advanced life support for responders in services that provide care to children
  • Putting systems in place to provide evidence of clinicians’ ongoing competence in advanced life support – clinicians need regular opportunities to practise and maintain their skills so that they retain competency1,2
  • Ensuring that clinicians who respond to acute deterioration also have non-technical skills such as graded assertiveness, negotiating patient goals of care, communicating bad news and team leadership3
  • Scheduling training for registered nurses in a first-line emergency care course in health services without 24-hour medical coverage
  • Using external providers such as local general practitioners, visiting medical officers or ambulance services; in some situations, the use of retrieval services to provide an emergency response may also be required.

When clinicians with advanced life support skills are located off site, response times need to be rapid so that patient safety and care are not compromised. This may require the clinician to be contacted early during a patient’s episode of deterioration, or if response times are prolonged, the capacity to have the clinician on site.

Hospitals

Ensure that response systems include provision for rapid access to at least one clinician with advanced life support skills at all times. Develop and maintain rosters to enable rapid access to this clinician at all times. In most large health services, this clinician will be accessed through the rapid response system.

Establish clinicians’ competence in advanced life support with evidence of relevant qualifications (for example, advanced life support certification compliant with Australian Resuscitation Council guidelines or medical qualifications in specialties such as anaesthesia and critical care). Establish competence in paediatric advanced life support for responders in services that provide care to children. More clinicians may require training so this level of care can be provided 24 hours a day and when key clinicians are absent.

Clinicians need regular opportunities to practise and maintain their skills so that they retain competence.1,2 Put systems in place to provide evidence of clinicians’ ongoing competence in advanced life support. This may require the organisation to provide access to formal advanced life support training for clinicians. Further benefits can be gained by providing opportunities for members of rapid response teams to train together, and practise using non-technical skills such as leadership, teamwork and communication while managing simulated scenarios of acute deterioration.

Day Procedure Services

Ensure that response systems include provision for rapid access to at least one clinician with advanced life support skills at all times. Depending on the size, location and type of day procedure service, options to provide this access include:

  • Supporting senior nurses to complete advanced life support training
  • Developing agreements with anaesthetists who provide services in the organisation
  • Accessing external ambulance services.

If advanced life support is to be provided by members of the workforce, establish clinicians’ competence in advanced life support with evidence of relevant qualifications (for example, advanced life support certification compliant with Australian Resuscitation Council guidelines or medical qualifications in specialities such as anaesthesia and critical care). Establish competence in paediatric advanced life support for responders in services that provide care to children. More clinicians may require training so that this level of care can be provided when key clinicians are absent.

Clinicians need regular opportunities to practise and maintain their skills so that they retain competence.1,2 Put systems in place to provide evidence of clinicians’ ongoing competence in advanced life support. This may require the organisation to provide access to formal advanced life support training for clinicians. Additional benefits can be gained by providing opportunities for members of rapid response teams to train together, and practise using non-technical skills such as leadership, teamwork and communication while managing simulated scenarios of acute deterioration.

Examples of evidence

Select only examples currently in use:

  • Rosters of clinicians who can provide advanced life support
  • Audit results of episodes requiring advanced life support, to determine whether members of the workforce who can provide advanced life support were available
  • Employment documents that describe advanced life support roles, responsibilities and accountabilities
  • Evidence of qualifications or up-to-date certification for the provision of advanced life support
  • Policy documents for rapidly gaining access to a clinician who can provide advanced life support
  • Records of ongoing competency assessments for advanced life support
  • Training documents about non-technical skills relating to advanced life support, such as teamwork, team leadership and communication.

MPS & Small Hospitals

MPSs and small hospitals should provide a system to ensure rapid access to advanced life support for patients who acutely deteriorate. This includes provision for rapid access to at least one clinician with advanced life support skills at all times. Develop and maintain mechanisms to enable rapid access to this clinician(s) at all times.

Mechanisms may include:

  • Providing extra training to some doctors and nurses to ensure the required level of care can be provided 24 hours a day and when clinicians are absent; external training programs can be used to provide training in advanced life support skills if this cannot be provided locally
  • Establishing competency in paediatric advanced life support for responders in services that provide care to children
  • Putting systems in place to provide evidence of clinicians’ ongoing competence in advanced life support – clinicians need regular opportunities to practise and maintain their skills so that they retain competency1,2
  • Ensuring that clinicians who respond to acute deterioration also have non-technical skills such as graded assertiveness, negotiating patient goals of care, communicating bad news and team leadership3
  • Scheduling training for registered nurses in a first-line emergency care course in health services without 24-hour medical coverage
  • Using external providers such as local general practitioners, visiting medical officers or ambulance services; in some situations, the use of retrieval services to provide an emergency response may also be required.

When clinicians with advanced life support skills are located off site, response times need to be rapid so that patient safety and care are not compromised. This may require the clinician to be contacted early during a patient’s episode of deterioration, or if response times are prolonged, the capacity to have the clinician on site.

References 

  1. Hamilton R. Nurses’ knowledge and skill retention following cardiopulmonary resuscitation training: a review of the literature. J Adv Nurs 2005;51(3):288–97.
  2. Allen J, Currey J, Considine J. Annual resuscitation competency assessments: a review of the evidence. Aus Crit Care 2013;26(1):12–7.
  3. Australian Resuscitation Council. The ARC guidelines. Melbourne: ARC; 2016 (accessed Sep 2017).