Resuscitation training Resuscitation skills are generally taught to health professionals through courses in and advanced life support. These courses teach skills for the purpose of preserving or restoring life by the establishment of, and/or maintenance of, airway, breathing, circulation and associated emergency care. The Australian Resuscitation Council guidelines for basic life support recommend that, as a minimum, learning objectives for training must include: recognition of an emergency ability to call an emergency response provider competence in compressions and rescue breathing emotional preparation for the capability to act in an emergency. Nurses and allied health professionals are commonly required to undertake annual competency training days which include basic life support training. This is in accordance with the Australian Resuscitation Council recommendation that all those who are trained in cardiopulmonary resuscitation refresh their knowledge and skills at least annually. However, the effectiveness of this approach has been questioned. There is evidence that while knowledge is retained over time, practical resuscitation skills decay more quickly. An Australian review in 2013 concluded that there is little evidence to support the widespread requirement for annual resuscitation training for experienced critical care nurses. This review recommended a shift to maintenance of resuscitation skills, rather than completion of assessments. Despite hospitals making significant investments in resuscitation training, and cardiac arrest there has been little associated improvement in mortality rates over the last 40 years. Failures to improve mortality rates may in part be because when cardiopulmonary arrest occurs, it is often as the end point of failures to detect or adequately respond to a person’s clinical deterioration while it is potentially reversible. Interdisciplinary training courses Since the advent of formalised recognition and response systems, efforts have been made by acute care providers to move the focus of training courses to earlier in the continuum of clinical deterioration. A number of interdisciplinary courses have been developed in and internationally with the purpose of teaching post-graduate hospital-based clinicians the skills and knowledge required for more timely and effective recognition and response to clinical deterioration. The content of these courses generally includes: signs, symptoms and triggers for detecting deterioration systems for escalating care systematic, rapid, prioritised assessment and treatment of the person’s physical deterioration common causes of clinical deterioration such as sepsis and hypoglycaemia non-technical skills such as communication and teamwork hospital
In 2009, the United Kingdom’s National Health Service (NHS) released a framework of core competencies for responding to acutely ill patients in hospital. These identify the key skills and knowledge required by different care providers to respond to various clinical scenarios according to their role and responsibilities. In this framework basic life support training is recommended as a mandatory requirement for all employees, including non-clinical staff. The competency framework has now been archived and there is no available information regarding evaluation of the implementation or impact of these competencies in practice. The NHS competency framework is available for download from: The intention of Standard 9 is to ensure that systems are in place to support the clinical workforce to recognise clinical deterioration and provide an appropriate and timely response. Action 9.6.1 stipulates that basic life support training is one of the mechanisms to ensure that the clinical workforce have the essential skills and training to achieve this. This is consistent with the traditional approach of annual resuscitation training for nurses and allied health staff, and with recommendations made by organisations such as the National Institute of Clinical Excellence in the . However, there is evidence that delayed or inadequate recognition of deterioration and/or escalation of care (commonly described as afferent limb failure) are the most commonly reported points of failure in recognition and response systems. While some professional groups, such as anaesthetists or intensive care physicians, will need training that far exceeds any minimum requirement, it seems reasonable that patients should be assured that any clinician providing patient care in an acute health service has achieved a minimum standard of competency in the skills required to recognise clinical deterioration, escalate care, and provide a timely and appropriate response while awaiting help from responders with advanced clinical skills. Currently there are varied approaches to providing training and education related to recognising and responding to clinical deterioration. There is a lack of clear and specific agreement, guidance or evidence about what knowledge is required as a minimum standard for all clinicians providing patient care, how it should be taught, and how competency should be assessed. To provide clarity in the requirements of the NSQHS Standards, and to ensure that patients are protected from harm, the Commission is seeking further information about the minimum standard that should be required for competence in the skills and knowledge required to provide safe care to patients who deteriorate in acute care settings.