This is why we all need ALS training, especially in the country!
In Victoria, many small rural health services, community health services and satellite health services rely on doctors or Ambulance Victoria to attend to patients who present at their service for urgent care. In these health services, a doctor is often not on site and may not be able to be contacted when a patient arrives or is already in the care of the service. It may take some time for the doctor to arrive at the health service in an emergency situation. In some rural towns there are no general practitioners at all!
In circumstances like these, and in the event of a person presenting in cardiac arrest, it is vital that a registered nurse or midwife (appropriately educated and skilled in both Basic Life Support and Advanced Life Support) is able to manage the patient while awaiting attendance of the GP or Ambulance Victoria. An effective and prompt response must be undertaken. This response will include BLS measures, including defibrillation and effective CPR, but the administration of lifesaving medications (adrenaline and amiodarone), in accordance with ALS guidelines, has always been a stumbling block.
In 2015, the ANMF (Vic Branch) participated in discussions regarding changes around Drugs and Poisons regulations. These discussions concluded with the successful Secretary Approval Agreement. This agreement authorised that RNs and midwives could possess and administer adrenaline and amiodarone as a part of ALS, under certain circumstances. The approval effectively gives RNs and midwives more abilities to save lives in the event of a cardiac arrest. The Agreement was released and dated 13th July 2015.
Although this is a huge professional win, and of clear clinical benefit to rural hospitals and their patients, this can only happen if the employer has proactively taken the steps to meet Australian Resuscitation Council (ARC) guidelines. Employers must ensure their policies and procedures consider the new therapeutic rights. The drugs may only be obtained from the health services that the RN or midwife is employed with. The employer’s policies and procedures must also address end of life considerations for patients. Health organisations must have an established process, as well as a list of ALS trained staff, which is available to all staff on all shifts. It is important to remember the administration of these drugs can only occur when the RN or registered midwife has completed a course that conforms to ARC guidelines. Annual refresher training is also mandatory.
The staff who do LearnPRN’s ALS nurse training day do receive education re the drugs, and it is reinforced in our online refresher. We have already flagged the change of legislation in the online education program. BUT…
What I am interested to hear are the management and policy level discussions about how this will be translated into policy to cover practice, such as
- How many doses of each drug?
- What dilution/ ratio/ routes are we endorsing?
- What is the checking policy in cardiac arrest?
- How will it be documented?
- Is conscious VT an arrest? Or is the amiodarone only if unconscious?
- How does this change affect calling for immediate medical help?
Big topics! The change to the legislation provides none of these answers. And, please, we would LOVE to hear see any responses to these questions, or for you to share your policies to help others! We’d like to hear from nurses from other states too.