Medical Emergency Team Procedure...team or staff member as delegated. 5.5 COMPOSITION OF MET TEAMS...

Procedure Version 7.0

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Medical Emergency Team (MET) procedure CALVARY PUBLIC HOSPITAL BRUCE

Function: Emergency care

Approved by: CPHB Director of Clinical Services - Nursing and Midwifery Approved Date: 11/02/2020

UNCONTROLLED WHEN PRINTED Review Date: 28/02/2023

of 27 Continuing the Mission of the Sisters of the Little Company of Mary

Medical Emergency Team (MET) Procedure Contents

1 Applies to ................................................................................................................................................ 2

2 Purpose………….. ....................................................................................................................................... 2

3 Responsibilities ........................................................................................................................................ 2

4 Equipment ............................................................................................................................................... 2

5 Procedure ................................................................................................................................................ 3

5.1 ACTIVATION OF MET ..................................................................................................................... 3

5.2 MET COVERAGE ............................................................................................................................ 4

5.3 COMMUNICATION AND COURTESY SURROUNDING MET CALLS ................................................. 6

5.4 PAEDIATRIC OR NEONATAL MET .................................................................................................. 6

5.5 COMPOSITION OF MET TEAMS ..................................................................................................... 6

5.6 ROLES OF MET MEMBERS ............................................................................................................. 7

5.7 METS AT THE PRIVATE HOSPITAL ................................................................................................. 9

5.8 METS IN SPECIALITY AREAS ......................................................................................................... 10

5.9 DISPOSITION OF PATIENT FOLLOWING MET .............................................................................. 10

5.10 MET CALL ENDING IN A DEATH ................................................................................................... 11

11 Related Calvary Documents .................................................................................................................... 11

12 Definitions ............................................................................................................................................. 11

13 References ............................................................................................................................................. 11

Appendix One – MET 1 Trolley contents ....................................................................................................... 13

Appendix Two – MET 2 Trolley contents ....................................................................................................... 17

Appendix Three – Contents of Ward Deteriorating Patient Trolleys ............................................................... 23

Appendix Four – Location of Hospital Wide Resuscitation Equipment ............................................................ 25


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1 Applies to

This Procedure applies to:

All staff

2 Purpose

Detection and response to patient deterioration is part of the National Safety and Quality Health Service (NSQHS) Standards and requires a hospital-wide response.

The Medical Emergency Team (MET) at Calvary Public Hospital Bruce (CPHB) is designed to respond to signs of deterioration in patients, staff or visitors; provide immediate assessment, and appropriate and timely management. The MET will respond to calls for adult, paediatric and neonatal emergencies.

3 Responsibilities

Calvary Executive

Ensure that this procedure is made available to all staff who may need to call or respond to a MET

Medical Officers

Ensure that their practice is in accordance with this procedure

Nurse Managers/ Educators/Medical Directors/Allied Health Directors

Ensure that staff are made aware of this procedure

Provides access to relevant training opportunities

Ensure that staff are up to date with mandatory training requirements

Investigate any incidents of non-compliance to the procedure, and enter in Riskman2

All Clinical Staff:

Ensure that their practice is in accordance with the guidelines set out in this procedure

Notify non-compliance with the procedure to their manager and enter in Riskman2

Non Clinical Staff

Ensure that their practice is in accordance with the guidelines set out in this procedure

Administrative Service/Switch Board

When notified of a MET, alert all members via paging system

4 Equipment

MET trolley

MET S4’s – S8’s under legislation cannot be carried on the trolley and will need to be obtained from the nearest clinical location

Swipe pass to Calvary Public Hospital Bruce

Swipe pass to Calvary Bruce Private Hospital (CBPH)

Pager to be carried by all members of the MET (and UHF radio when paging system down)


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5 Procedure

5.1 ACTIVATION OF MET

A MET call can be activated by ANYONE contacting the switchboard on 2222 and specifying the location and type of emergency. They can also be activated by pressing a (red) MET call button in certain areas of each ward.

MET calls are usually initiated for medical emergencies but may be prompted by any situation where there is a perceived need for urgent medical assistance. Calls can be prompted by any situation that meets the call out criteria listed below:

5.1.1 MET CALL CRITERIA:

AIRWAY: THREATENED

BREATHING: ALL RESPIRATORY ARRESTS

Respiratory rate ≤ 4 or ≥ 36

SpO2 ≤ 84

CIRCULATION: ALL CARDIAC ARRESTS

Pulse ≤ 39 or ≥ 140

Symptomatic Systolic BP ≤ 90 or ≥ 190

DISABILITY: SUDDEN DROP IN LEVEL OF CONSCIOUSNESS

Repeat or prolonged seizures

OTHER: ANY OBSERVATION IN THE MET/MEWS 4 ZONE

Any other patient that you are worried about that does not fit the above criteria

The MET call criteria may be varied for a particular patient with a chronic condition (for example SpO2 88-92% in a Chronic Obstructive Pulmonary Disease (COPD) patient). Variance should be documented on the patient’s observation chart by a Registrar or Consultant. The revised criteria will be subject to review on an ongoing basis according to the patient’s condition.

A variance should not be used in acute conditions.

5.1.2 Process for activation of MET

o Internal - DIAL 2222 on any Calvary phone

TO CALL A MET, DIAL 2222 AND STATE THE EXACT LOCATION AND TYPE OF MEDICAL EMERGENCY

SPECIFY CLEARLY IF A PAEDIATRIC OR NEONATAL MET RESPONSE IS REQUIRED


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o External - call hospital switch on 6201 6111

o The following information must be given to the switchboard operator:

That it is a MET call you are requesting

Specify clearly if the MET is for a paediatric, neonatal patient, or multiple patients

Specify clearly if the MET is for an arrested patient

Location of the MET incident, e.g. “Ward 4W Bed 12A”

Calling criteria, e.g. “Breathing”

Ward staff must page inpatient home team, or ask switch to do so

Do not hang up until the switch operator gives that instruction.

5.1.3 Switchboard Operators Responsibility

If the 2222 telephone located at switch receives a call, the operator is to immediately answer the phone.

The operator will ask the caller to state the nature and the exact location of the emergency, and instruct the caller when they can hang up, as detailed above. The operator will then activate the group-MET page and record the call (date, time and area) in the MET log document.

Testing of the MET pagers will occur every Wednesday. All members of the MET must respond to switch to confirm that they received the test page.

Switch will make UHF radios available to all MET members in the event of pager testing or failure.

5.1.4 Stand down of a MET call

A MET call can be stood down when there is agreement between the MET Team Leader (T/L) and MET team that the patient is stable and no longer requires ongoing management from the MET.

Documentation should be made in the progress notes by the inpatient team registrar confirming their agreement to the stand call of the call, and outlining the ongoing treatment plan. See section 5.9 for additional information regarding disposition of patient following a MET.

Switch is to be notified (by the MET RN) of stand-down of MET after the MET Registered Nurse (RN) has returned to the MET base station and restocked the MET trolley.

5.2 MET COVERAGE

CPHB MET coverage is provided to all inpatient and outpatient areas,as shown in figure 1 and outlined below:

Internal

Lewisham building – including the Library and Outpatient Clinics

Xavier building

O’Shannassy Building


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Marion Building

External

Engineering block

Car Parks - (MET activation +/- 000 call)

The Bruce Ridge Early Child Care Centre (BRECC) – (MET activation +/- 000 call)

Rotary Cottage

Mary Potter circuit

Sylvia Curly road

Private

Calvary Bruce Private Hospital

Calvary Clinic (MET activation +/- 000 call)

Hyson Green (MET activation +/- 000 call)

MET attendees at a Private Hospital medical emergency will include:

CPHB MET RN

CPHB Intensive Care Unit (ICU) registrar and anaesthetics registrar

CBPH After Hours Hospital Manager (AHHM)/High Dependency Unit (HDU) Manager

CBPH bedside nurse and additional staff as required

CBPH Ward Services Officer (WSO) – if none available, the CPHB WSO can be requested via the CPHB AHHM

CBPH Pastoral care – if none available, the CPHB Pastoral care can be requested via the CPHB AHHM

CPHB Intensive Care Liaison Service (ICLS) may also provide assistance upon request.

Areas not covered by MET are:

Hennessy House

Arcadia House

Haydon drive and associated bus stops

Bruce Ridge Nature Reserve

In these areas an ambulance must be called by dialling 000.


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Figure 1

5.3 COMMUNICATION AND COURTESY SURROUNDING MET CALLS

Members of the MET team should conduct themselves professionally at all times.

If you encounter unprofessional behaviour during a MET, this should be reported to either the ICU liaison, AHHM, or the MET consultant; AND by submitting a complaint into Riskman2.

5.4 PAEDIATRIC OR NEONATAL MET

If a paediatric or neonatal MET is activated a senior Emergency Department (ED) medical officer will need to attend with the MET nurse. This person needs to be competent in Neonatal Advanced Life Support (NALS) and Paediatric Advanced Life Support (PALS).

For a neonatal MET, the on-call paediatrician should be paged also. This can be done by any member of the MET team or staff member as delegated.

5.5 COMPOSITION OF MET TEAMS

Calvary Public Hospital Bruce has two MET teams allocated each shift.

MET 1: is the primary response team

MET 2: is only activated if MET 1 is already attending a call, or MET 1 needs additional resources.

The two MET trolleys and MET RN’s are based in the Emergency Department.


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The ED Admitting Officer (AO) is responsible for allocating an ED doctor to attend a paediatric/neonatal MET, and MET2.

MET 1

o ICU Registrar o MET Medical Registrar o Anaesthetic Registrar o ED MET 1 RN o ICU Liaison nurse or AHHM o WSO o Pastoral care worker

MET 2

o ED Registrar o ED MET 2 RN o ICU Liaison nurse or AHHM o WSO

Resources from MET 1 will be deployed to MET2 as soon as available The ED Clinical Manager (CM) and AO both receive all MET 1 and MET 2 pages so that they know which staff members are off the floor, and the AO can delegate a registrar to attend a Neonatal or Paediatric MET call, or MET 2.

The ICU, medical or anaesthetic registrar will attend MET 2 if not required at MET 1.

All members of the MET carry a designated MET pager which is handed on shift to shift.

If a MET member is unable to attend a MET they must contact switch board so that switch can notify the MET RN and so that they and the MET TL can make a decision as to whether other resources are required (i.e. MET2). If a MET member does not respond at all it is the responsibility of the ICU liaison nurse or shift coordinator to find out why and ensure that the MET pager, carried by the MET member, is working. A Riskman2 report should be made if a member of the MET team does not respond.

5.6 ROLES OF MET MEMBERS

5.6.1 Team Leader

The MET team leader will usually be the ICU Registrar (or ED registrar in MET 2). However, if the Medical Registrar or Anaesthetic Registrar is performing the role of TL before the ICU Registrar arrives, they do not necessarily need to hand over the role. All three can work together to achieve a good outcome for the patient.

Team leadership during an ALS scenario will be based on the specific situation, skill requirement and qualification of available staff. For example an arrested patient may precipitate a change of team leader if specialised skills are required to obtain a definitive airway.

All members of MET are required to physically respond to a MET call.


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The Team leader should clearly identify themselves as the Team Leader

o Is responsible for designating the roles of the other team members including: o Airway & breathing support o Access, fluids & drugs o Compressions o Defibrillation o Scribe/Timekeeper

o Can call for extra help or dismiss team members if they are not required o Directs the treatment of the patient with advice from other team members and the patient’s

treating team as appropriate (The treating team should be involved in the MET as early as possible to provide better coordinated clinical decisions regarding the patient)

o Arranges notification of the treating team about the MET call and management o Completes the MET record form. This will become part of the Medical Record and no further

documentation needs to be attended in the patient’s notes o Determines the disposition of the patient in consultation with the ICU or ED consultant, and the

treating team o In conjunction with the inpatient team, contacts and discusses clinical deterioration with the

patient, family and carers o If the decision is made that the patient does not require transfer to ICU, ensures handover to

the medical registrar. o The home team consultant should be notified of all METs, unless at the discretion of the MET TL.

This reason should be recorded within the MET documentation. o The treating consultant should review all MET call patients within 24 hours post MET call.

5.6.2 The Medical registrar

The medical registrar will assist as part of the team depending on the staff mix present and the clinical situation. The medical registrar will assume the team leader role until the ICU registrar arrives.

5.6.3 The Anaesthetic registrar

The Anaesthetic registrar’s key role is in management of airway and breathing but they will also assist as part of the team depending on the staff mix present and the clinical situation. The anaesthetic registrar may need to assume the team leader role until the Medical or ICU Registrar arrives.

5.6.4 MET Registered Nurse

The MET RN will take the MET trolley to the MET call. This trolley contains the emergency medications, equipment and a monitor/defibrillator. The MET RN has a key role in providing monitoring of the patient and assistance for all medical staff in provision of drugs and equipment as required during the MET call. The MET RN may need to care for the patient in the ward or ICU whilst awaiting transfer and/or arrangement of appropriate nursing staff to take over care of the patient.

5.6.5 ED doctor

The ED AO must delegate an appropriate Medical officer to attend a Paediatric, Neonatal or MET2.

If MET 2 is activated an ED medical officer will need to attend with the MET 2 RN – this person needs to be competent in ALS and airway skills


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5.6.6 Intensive Care Liaison Nurse

The ICU liaison will assist the AHHM and MET RN and Registrars where necessary and coordinate staffing and bed issues when transfer is required.

The ICU liaison nurse will follow up all MET calls within 24 - 48 hours when the service is available.

5.6.7 Wards Support Officer

The responsibilities of the wards person is to perform CPR, transport blood and other samples to pathology for urgent assessment, and facilitate patient access, movement and transport.

5.6.8 After Hours Hospital Manager

The responsibilities of the AHHM include: acquiring extra resources as required, assist with workflow, assist with plans to transfer patient if required, remove excess staff from area, assist with MET where clinically appropriate, oversite of timeliness of completion of MET and transfer of patient to suitable clinical area.

5.6.9 Ward RN

The first RN on the scene should provide a handover to the MET TL using an ISBAR approach. In addition, the RN responsible for the patient should be available to provide a brief, relevant clinical history to the MET on arrival.

At least one ward RN must remain with the MET to assist with scribing, drug administration, and other needs as directed by the MET TL.

5.6.10 Pastoral Care

The responsibility of Pastoral Care is to provide spiritual and emotional support to the patient, their family, other patients and staff.

Pastoral Care will attend MET calls 7 days a week, from 0800 – 1600. Outside of these hours, Pastoral Care can be paged to attend medical emergencies, and unexpected deaths through the AHHM.

5.7 METS AT THE PRIVATE HOSPITAL

5.7.1 Calvary Bruce Private Hospital

Internal Assistance

Press red button – internal assistance.

As per Internal Emergency Medical Response Procedure.

External Assistance (CPHB)

Dial 2222 to request a MET

MET team from CPHB will attend

Internal MET team to bring MET trolley.

5.7.2 Hyson Green

Dial 2222 to request a MET. Ambulance may also be required to transport patient.


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5.7.3 Calvary Clinic

Dial 2222 to request a MET. Ambulance may also be required to transport patient.

5.8 METS IN SPECIALITY AREAS

In specialty areas, roles and leadership are to be allocated according to staff specialist skill sets.

Maternity

Internal emergency response utilised

MET activated when external help required. Specify if neonatal, paediatric or obstetric patient.

Theatres / Recovery

Internal emergency response utilised 7am – 7pm

External response (MET) 7pm – 7am and weekends, or when internal response identifies need for extra help.

Intensive Care Unit / Coronary Care Unit / Emergency Department

Internal emergency response utilised

MET response activated when external help required.

5.9 DISPOSITION OF PATIENT FOLLOWING MET

It is the responsibility of the MET TL to liaise with the appropriate Consultant when transfer of a patient is deemed necessary. If conflict arises over the treatment of the patient during a MET then the primary care Consultant should be called to clarify the situation.

The MET TL is able to document a Medical Orders for Life-Sustaining Treatment (MOLST) for the patient if they feel it is the best course of action for the patient at the time of the MET. It is the MET TL’s responsibility to inform the primary care Consultant and team about this decision.

5.9.1 Transfer to ICU/CCU/ED/OT

All non-inpatient MET calls requiring escalation are to be transferred to the Emergency Department for assessment and management. The ED CM must be notified of any patient being transferred to the ED prior to leaving the scene of the MET to allow arranging an appropriate location to receive the patient.

All inpatient MET calls requiring escalation are to be transferred to ICU or CCU. If however an ICU/CCU bed is not available immediately the AHHM in consultation with the MET team will plan the safest environment to care for the patient. ICLS or the MET RN will assist in managing the patient until transfer can be achieved.

5.9.2 Remain on ward

When the decision is made that the patient remain on the ward post MET, it is the responsibility of the MET TL to arrange appropriate and timely review of the patient. Review post MET must be within 4 hours.

Vital signs as per the Adult Vital Signs.docx

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Adult%20Vital%20Signs.docx&action=default


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5.10 MET CALL ENDING IN A DEATH

If the patient dies during a MET it must first be decided if the case requires a coronial referral. It is the MET TL’s responsibility to notify the primary care Consultant of the death and determine coronial referral status. Ensure clear documentation at the time around discussions, and NOK is notified.

Patient to be managed as per Management of deceased person procedure.docx

6 Related Calvary Documents

ICU Admission Policy

Coronary Care Unit Admission and Discharge Criteria

Internal Emergency Medical Response Procedure (private)

Emergency Management Policy

Recognition and response to deterioration policy

Adult Vital Signs procedure

Maternity Vital Signs procedure

Paediatric Vital Signs procedure

Neonatal Vital Signs

Management of deceased person procedure

Management of delirium and disturbed patient behaviour – Procedure

Management of postpartum haemorrhage procedure

Procedures for activation of massive transfusion protocol and activation of code Crimson

Post resuscitation care for infants procedureP

Resuscitation of the Newborn Infant

Sepsis – Emergency Department Clinical Procedure

Stroke Service (SS) admission, discharge and management

Management of Alteplase administration for patients with acute ischemic strokes

Healthcare Record Management – Advance Care Planning policy

Healthcare Record Management – Advance Care Planning procedure

Transport of critically ill and or high risk patients (intra-hospital) procedure

7 Definitions

ARC – Australian Resuscitation Council

AED – Automatic External Defibrillator

ISBAR – communication mnemonic – Identify, Situation, Background, Assessment, Recommendation

Lifepak/Monitor -

NSQHS – National Safety and Quality Health Service

8 References

Australian Commission on Safety and Quality in Health Care www.safetyandquality.gov.au

Australian Resuscitation Council resus.org.au

Joint position statement on rapid response systems in Australia and New Zealand, and the roles of Intensive Care www.cicm.org.au

Jones. D. 2009 “The Role of a Medical Emergency Team in a Teaching Hospital” PhD thesis

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Management%20of%20deceased%20person%20procedure.docx&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/ICU%20Admission%20policy.docm&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Coronary%20Care%20Unit%20Admission%20and%20Discharge%20Criteria%20.docm&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/CHCBrucePolicyCommittee/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/CHCBrucePolicyCommittee/Shared%20Documents/Emergency%20Management%20Policy.docx&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/AuthoringLibrary/MET%20policy.docx&action=default

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Adult%20Vital%20Signs.docx&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Maternity%20Vital%20Signs.docx&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Paediatric%20Vital%20Signs.docx&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Neonatal%20Vital%20Signs.docx&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Management%20of%20deceased%20person%20procedure.docx&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Management%20of%20delirium%20and%20distrubed%20patient%20procedure.docx&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Management%20of%20postpartum%20haemorrhage%20procedure.docx&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Procedures%20for%20activation%20of%20Massive%20Transfusion%20Protocol%20and%20Activation%20of%20Code%20Crimson.docx&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Post%20Resuscitation%20Care%20for%20Infants.docx&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Resuscitation%20of%20the%20Newborn%20Infant.docx&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Sepsis-%20Emergency%20Department%20Clinical%20Procedure.docm&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Stroke%20Service%20admission%20discharge%20and%20management.docx&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Management%20of%20Alteplase%20Administration%20for%20patients%20with%20Acute%20Ischaemic%20Stroke.docx&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/CHCBrucePolicyCommittee/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/CHCBrucePolicyCommittee/Shared%20Documents/Healthcare%20Record%20Management-%20Advance%20Care%20Planning%20policy.docx&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/CHCBrucePolicyCommittee/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/CHCBrucePolicyCommittee/Shared%20Documents/Healthcare%20Record-Advance%20Care%20Planning%20procedure.docx&action=default&DefaultItemOpen=1

http://connect.calvarycare.org.au/committees/clinical/PublicHospitals/BrucePublic/_layouts/15/WopiFrame.aspx?sourcedoc=/committees/clinical/PublicHospitals/BrucePublic/Shared%20Documents/Transport%20of%20critically%20ill%20and%20or%20high%20risk%20patients%20(intra-hospital).docx&action=default&DefaultItemOpen=1

http://www.safetyandquality.gov.au/

https://resus.org.au/

http://www.cicm.org.au/


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Verma. KP, Jasiowski. S, and Jones. K. 2015 “Revitalising the medical emergency team call” CritCare19p409

Farida M. Jeejeebhoy et al. “Cardiac Arrest in Pregnancy” Circulation. October 6, 2015

https://trauma.reach.vic.gov.au/guidelines/teamwork-and-communication/key-attributes-of-an-effective-team




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Appendix One – MET 1 Trolley contents

Top Size / Comments Qty Paed Lifepak defibrillator -Multipurpose cable with test pod,

Quick combo gel pads attached -ECG cable with electrodes attached -NIBP cable and adult cuff attached -SpO2 cable and probe attached

Oxygen cylinder with Twin-O-Vac attached

-Suction tubing and Yankeur attached

Adult Laerdal Bag Valve Mask, PEEP valve, tubing

Sharps container

Disposable gloves Small/Medium/Large

Chlorhex hand wash

Scissors 1

Stethoscope 1

S8 Drug box Contents listed below

Safety goggles 2

Blue folder, MET clipboard and forms, S8 book

Laminated emergency algorithms BLS, ALS, PALS, NALS, COACHED

Airway Size / Comments Qty Paed Guedel airways 2, 3, 4 1 each 000, 00,

0, 1

Nasopharyngeal airways 6.5, 7, 8 1 each

LMA iGel 3, 4, 5 1 each 1, 2

ET tubes Cuffed 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9

1 each Uncuffed 2.5, 3, 4, 5

Laryngoscope normal, skinny 1

Mac blades Curved 1 - 4 1 Straight 0, 1

Introducing stylet Adult 1 Paediatric

Bougie Adult 1 Paediatric

Frova 1

Magill’s Forceps Adult 1 Paediatric

10mL syringe luer slip 1

Y suction catheters 12, 14 2 each 8F

Yankeur sucker 1 Paed

Lubricant sachets 2

ETT cotton tape 1

Adhesive tape 1

Scissors, artery forceps 1


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Neuro torch 1

Tongue depressors 1

Batteries size C, AA 2

Difficult Airway Crico kit: Scalpel size 10, Bougie, Size 6 ETT

Trache dilator 1

Melker cricothyrotomy kit + scalpel

1

Cannula insufflation set up 14g insyte cannula, rotometer, oxygen tubing, t-piece

1

10mL syringe 1

20mL syringe 1

Breathing Size / Comments Qty Bag valve mask Adult 1

1 Paed Neonate

Hudson mask with tubing Adult 1 1

Paed Neonate

Non rebreather mask with tubing Adult 1 Paed

Nasal prongs 1 1

Paed Neonate

Face mask 3, 4, 5 1 0, 1, 2

Neb mask Adult 1 Paed

Neb chamber Adult 1 Paed

Easy cap CO2 detector Adult 1 Paed

PEEP valve 1

Filter 1

Flexi tube connector, swivel elbow

1

Disposable SpO2 sensors Adult 1 Paed

Circulation Size / Comments Qty Defib pads Adult 1 Paed

IO kit Drills: electric, manual Needles: 15, 25, 45 Chlorhex stick swabs

1 1 each 2

Tourniquet 2

IV cannula 14g 16g 18g 20g 22g 2 each

Butterfly needles 21g 23g 25g 2 each

Needles 19g 23g 25g Blunt 5 each

Tegaderm IV, large 5 each

Bandage 1

Sterile gauze 10

Pressure pads 10

Chlorhex and alcohol swabs 20


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Micropore tape 2

Bungs Red, smart site 5 each

3-way taps 2

Syringes 1ml 5ml 10ml 20ml 50ml

2 4 10 5 2

Drug additive labels 10

Normal Saline prefilled 10mL syringes

10

Normal Saline prefilled 5mL syringes

10

Water for injection 10mL 5

Blood gas syringes 2

Pathology tubes pink, blue, green 2

Blood culture bottles 1 each

Vacutainers 2

Pathology bags / tubes / forms 2 Paed

Sterile scissors 1

Sterile artery forceps 1

Wire cutting scissors 1

Cardiac monitor dots Adult 1 pkt Paed

Blood pressure cuffs 10, 12 1 each 1,3,4, 8,9

Broselow tape 1

Drugs Size / Comments Qty First Line Drugs

Adrenaline (epinephrine) 1:10,000 amps

5

Atropine 600microg/1mL inj 3

Amiodarone 150mg/3mL inj In 5% Glucose 100mL 2

Glyceryl trinitrate 600microg subling tabs OR 400 microg subling spray

1

STEMI pack ticagrelor 90mg x 2 and aspirin 300mg tablets

1

Second Line Drugs Adrenaline (epinephrine) 1:1,000 amps

2

Adrenaline (epinephrine) 1:10,000 amps

5

Adenosine 6mg/2mL inj 5

Amiodarone 150mg/3mL inj 6

Atropine 600microg/1mL inj 4

Calcium Chloride 10% 1g/10mL inj

2

Dexamethasone 4mg/1mL inj 2


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Ephedrine 30mg/1mL inj (dilute 30mg in 30mL 0.9% sodium Chloride, 1mL=1mg, administer 5 – 25mg bolus)

2

Flumazenil 500 microg /5mL inj 2

Frusemide (Furosemide) 20mg/2mL inj

4

Glucagon 1mg kit inj 1

Glucose 50% 25g/50mL inj 1

Hydralazine 20mg/mL powder for reconstitution

(reconstitute to 20mL, 1mL=1mg, administer 5 – 10mg bolus)

1

Hydrocortisone 100mg/2mL 1

Ipratropium 250 microg nebs 1 packet

Lignocaine (Lidocaine) 1% inj 2

Magnesium Sulphate 10mmol/5mL amps

2

Metaraminol 10mg/1mL inj 2

Metoprolol 5mg/5mL inj 2

Naloxone 400microg/1mL amp 4

NSTEMI pack (clopidogrel 75mg x 8 and aspirin 300m tabs)

1

Salbutamol 5mg nebs 1 packet

Sodium Bicarbonate 8.4g/100mL 1

Eclampsia kits: Hydralazine and Magnesium Sulphate kept in birth suite and theatres

Locked in MET trolley drug safe

Diazepam 10mg/2mL amps 2

Midazolam 5mg/5mL amps 2

Potassium Chloride 10mmol/10mL amps

3

Propofol 200mg/20mL inj 2

Rocuronium 50mg/5mL inj 2

Suxamethonium 100mg/2mL inj 2

Extras / Fluids Size / Comments Qty Soft collars Adult 1 Paed

Wayne pneumothorax set 1

BGL machine kit 1

Sodium Chloride 0.9% 1000mL 1

Sodium Chloride 0.9% 100mL 1

Hartmanns 1000mL 1

Mannitol 20% 500mL 1

5% Dextrose 100mL 1

Alaris pump sets 1

Alaris low sorb pump set 1

IV blood pump sets 1

IV pump sets 2


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Appendix Two – MET 2 Trolley contents

MET TRANSPORT PACK CHECK LIST

Dillybags on handle of trolley

Bag 1 - Suction items

1 Yanker sucker,

1 suction tubing,

1 x spare Medtronic Defib/monitoring pad,

Adult ECG dots X 5,

1 Neuro penlight,

Adult Masimo SPO2 Sensor x 1

Bag 2

1 x Adult O2 Non-rebreather mask,

1 x Adult Ventimask,

1 X Adult Nebuliser Mask,

1 x Paediatric Nebuliser Mask,

1 x Nebuliser chamber,

1 x Oxygen tubing.

Bag 3(‘fishbag’)

1 x Stethoscope

2 x goggles,

BGL kit,

1 x Lifepac Printer Paper 10cm

1 pr each of medium, large, extra large non sterile gloves (in zip plastic bag).

1 x Scissors


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Other miscellaneous items:

Small ‘sharps bin’ x 1 on side of trolley

Check Met Record Sheet on Perspex board on trolley.

Check O2 cylinder full/Twin-o-vac are in working order

Hard Cervical Collar clipped to trolley.

Closed side view of MET bag

Lt side Rt side.

1/9. Nebules, Drug Bag

7. Difficult Airway-LMA’s, NGT’s

8. Paediatric items

10. IV Fluids,20ml syringes

Open view of MET bag (looking down)


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MET BAG

MAIN INNER COMPARTMENT CONTENTS

1. Front Outside Zip Pocket: see drug list and list in pocket.

2. Intravenous Access Kits X 2 in Main bag Compartment

External Pocket:

x 10 Alcohol wipes

Inside Cavity:

x 1 Vacuette Barrels

x 1 Pathology Specimen Bag

x 2 Pkt5 Gauze Squares

x 1 Small Bandage

x1Tournaquet

x 1 Paediatric Arm board

x 1 Tape

x 2 Additive Labels

x 1 Pathology Request Form

x 1 Pathology Group/Hold Form

1. Nebules (zipped side pocket)

2. IV access kits x 2

3. Intubation Kits/Cricoid set

4. Laerdal Bag/Masks/PEEP Valves

5. Intra-osseous Drill set (EZ10) 1 X of 15g drill bits. 5mm,25mm,45mm

6. IV Pump Set, Gelfusion x 1

8. Paediatric items (zipped Lt.side pocket)

9. Drug Pack (zipped side pocket)

10. IV Fluids, 20ml syringes (Rt. zipped side pocket)


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Front Inside Pocket:

x 2 Tegederm IV Dressings

x 1 20 mL syringe

x 2 10 mL syringe

x 1 5 mL syringe

x 1 2 mL syringe

x 1 ABG syringes

x 2 Drawing up cannulae

Front Inside Elastic:

x 2 each 24, 22, 20, 18, 16, 14G Cannulae

x 1 10mL 0.9% Sodium Chloride

x 1 10ml Sterile Water

Mid Satchel Flap:

x 1 each Coag, Lithium Hep Adult Pathology tubes, FBC x 2

x 1 each Coag , UEC’s, FBC x 2, Paed Pathology tubes

x 2 Alaris bungs

x 1 Paediatric Extension Set

x 2 each 25G, 23G, 21G, 19G Sterile needles,

x 2 vial access.

3.Intubation Kit( Separate bag in Main Compartment)

Front right side:

x 1 Magills Forceps (Adult)

x 1 Paediatric Introducer

x 1 Adult Introducer

x 1 each of 2.5,3.0, 4.0, 5.0 Uncuffed Paediatric ETT

x 1 each of 6.0, 7.0, 8.0,9.0 Cuffed Adult ETT

x 1Bougie Adult

x 1Bougie Paeds

x 1 each Fiber optic Adult blades sizes 1,2,3,4

x 1 swivel connector

x Bennets flex tube


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Middle Spine Section of Bag:

X 1 Laryngoscope Handle

x 2 KY Sachets

x 2 ETT Cotton Tape Lengths

x 2 C Size Batteries

Left side:

x 1 Paediatric Straight Blade

x 1 small Artery Forceps

x 1 10mL syringe

Zipper section:

x 1 Leukoplaste tape

x 1 Scissors

x 1 Lignocaine spray 1% 30mL

x 1 Side stream Capnostat Disposable lead

x 1 in line Capnostat monitor lead

Zipper Section:

X 1 Needle (cricothyroidotomy) jet Insufflation Set up

Beside closed Intubation Kit in main compartment:

x 1 Cricothyroid Puncture Set

Bag/Valve/Mask Compartment (Under top flap in zip pocket)

x 1 Adult Laerdal Bag/Valve/ Reservoir

x 1 each Guedal airway sizes 1,2,3,4

x 1 each Nasopharyngeal Airway sizes 6.5,7.5

x 1 each Face mask 3-4,4-5

x 1 Airway filter

x 1 PEEP valve 1-20 or orange valve 1-10/green 10-20 plus adaptor ring


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Intra Osseous (EZ1)Drill( Main Compartment)

x 1 15g 15mm Paediatric drill bit

x 1 15g 25mm Adult drill bit

x 1 15g 45mm Bariatric drill bit

Intraveneous Fluids/Sets in Main Compartment

x 2 Blood Pump Sets

x 1 500mL Gelfusion

Suction/Gastric /Laryngeal Airway Masks(Top Outside Zip Pocket)

x 1 each 10,14,16Fg Salem Sump tube with KY gel attached

x 1 each 8 ,12,14 Suction Y Catheters

x 1 Infant Feeding tube 8Fg

x 1 50ml Bladder syringe

x 1 each Laryngeal Airway Masks Sizes 2,3,4,5 with KY gel attached

x 1 60 ml Leurlock syringe for LMA’s

x 1 Salem Sump Anti-reflux Valves

x 1 ph Paper

x 1 Nasogastric drainage bag

Neonatal Airway/Monitoring Items(Left Zip Pocket)

x 1 each Oropharyngeal Airways Sizes 1,0,00,000

x 1 Neonatal Laerdal Bag valve mask

x 2 Neonatal Silicone Masks 00,2

x 1 Paediatric O2 Non Rebreather Mask

x 1.Paed/Neonate Masimo SPO2 Sensor

x 5 Paediatric ECG dots in small jar

x 1 Medtronic Paediatric Monitoring/defib Pad

x 1 Paed sucker

x 1Meconium sucker

x 1.Broselow Tape


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Appendix Three – Contents of Ward Deteriorating Patient Trolleys

Top / Side of trolley Quantity

Oxygen cylinder 1

Twin-O-Vac Suction, tubing and Yankeur attached 1

Laerdal Bag Valve Mask, tubing attached to oxygen cylinder 1

Sharps container 1

Stethoscope 1

Safety goggles 2

Chlorhex/alcohol hand wash 1

Check list 1

Sign sheets 1

Scribe clipboard, pen 1

Laminated emergency algorithms 1

Drawer A - Airway

Y suction catheters 12, 14, 16 1

Guedels oropharyngeal airways 2, 3, 4 1

Nasopharyngeal airways 6.5, 7, 7.5 1

Neuro torch 1

Scissors 1

Artery Forceps 1

Adhesive tape – Transpore, Leucoplast 1

Lubricant gel packet 6

Sterile gauze squares 2

Disposable razor 1

Pen 1

Drawer B - Breathing

Hudson mask 1

Non-Rebreather mask 1

Oxygen tubing 1

Mask – small adult size 3 1

Nasal Prongs 1

Nebuliser mask 1

Nebuliser chamber 1

Drawer C - Circulation

Tourniquet 2

IV access starter kit 1

IV cannula 18g 20g 22g 24g 2

Butterfly needles 21g 23g 3

Needles 19g 21g 23g 25g 6

Blunt drawing up needles 6

Tegaderm IV 4

Tegaderm large 4

Bandage 1

Gauze 10

Combine dressing 1


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Pressure pads 10

Chlorhex and alcohol wipes 10

Chlorhex and alcohol swab sticks 6

Bungs – red 4

Bungs – blue interlink 4

3-way tap 1

1ml syringe 1

5ml syringes 2

10ml luerlock syringes 10

20ml luerlock syringes 2

50ml luerlock syringe 1

Blood gas syringes 2

Pathology tubes: pink, blue, green 2

Blood Culture bottles 2

Vacutainers 2

Pathology bags 5

Drawer D – Drugs / IV Fluids

Prefilled normal saline 10ml syringes 5

Prefilled normal saline 5ml syringes 5

0.9% Sodium Chloride 10mL ampules 10

IV additive labels 5

0.9% Sodium Chloride 1000mL bag 1

Hartmanns 1000mL bag 1

IV pump sets 2

Drawer E - Extras

Sterile gloves 6.5, 7, 7.5, 8, 8.5, 9 1

2% Chlorhexidine in 70% Alcohol prep solution 1

Disposable gloves Small / Medium / Large 1

Red drawer locking devices 20

Check red seal, Oxygen cylinder over half full, Suction functioning, IV fluids in date BVM & all top/side of trolley items each day

Record on daily checking list

Open trolley and check all contents on the last day of each month, for expiry dates and to ensure all items are present

Nearest AED identified

All trolleys hospital wide standardised

All drawers clearly labelled


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Appendix Four – Location of Hospital Wide Resuscitation Equipment

Critical Care Areas Emergency / ALS Equipment Deteriorating Patient Equipment

MET 1 Lifepak Emergency trolley

MET 2 Lifepak Emergency trolley

ED Resus room Lifepak Emergency trolley Paediatric/Broselow trolley

ED Acute Area Lifepak Emergency trolley

SSU Lifepak

ICU Lifepak Emergency trolley Difficult airway trolley

CCU Lifepak Emergency trolley Pacing trolley

Recovery Lifepak Emergency trolley Paediatric/Broselow trolley

Theatres Lifepak Emergency trolley Difficult airway trolley Malignant HT trolley CICO in all theatres

Exercise stress test room AED BLS kit Portable oxygen, suction, BVM

Inpatient Wards Emergency / ALS Equipment Deteriorating Patient Equipment

4W AED Deteriorating patient trolley

4E Deteriorating patient trolley

5W Deteriorating patient trolley

MAPU AED Deteriorating patient trolley

Stroke Unit Use MAPU equipment

6W AED Deteriorating patient trolley

6E / HITH Deteriorating patient trolley

Acacia (Mental Health) AED in HITH Oxygen, suction, BVM Deteriorating patient trolley

OPMH AED Deteriorating patient trolley


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Maternity Emergency / ALS Equipment Deteriorating Patient Equipment

3S / postnatal ward Neonatal resuscitaire PPH kit

AED Deteriorating patient trolley

Birth Suite Neonatal resuscitaire Maternal resuscitation trolley PPH kit, Eclampsia kit

AED

SCN Neonatal resuscitaire Emergency trolley

Portable oxygen, suction, BVM

Birth Centre Neonatal resuscitaire AED Oxygen, suction, BVM

Maternity Assessment Area Neonatal resuscitaire AED Oxygen, suction, BVM

Outpatient Areas Emergency / ALS Equipment Deteriorating Patient Equipment

Endoscopy Lifepak Emergency trolley

AED

Physiotherapy / gym AED Emergency Equipment backpack Portable oxygen, suction, BVM

Radiology AED Anaphylaxis kit x3 Oxygen, suction, BVM

MRI Adrenaline 1:10,000 x 10 Epipens 150mcg & 300mcg Oxygen, suction, BVM

Specialty clinics / Preadmission clinic

AED Deteriorating patient trolley

Zita Mary Oxygen, suction, BVM

Cardiac Rehab Portable Zoll Defib/AED

Infection Control/Staff Health Oxygen, masks, IV access kit Adrenaline 1:1000

Administration areas Emergency / ALS Equipment Deteriorating Patient Equipment

O’Shannassy Building AED

Switchboard AED, St Johns first aid kit

PFU AED

Private Emergency / ALS Equipment Deteriorating Patient Equipment

Calvary Bruce Private Hospital:

HDU: - Lifepak - Emergency trolley - Difficult airway trolley

Wards - AED’s on all floors - Deteriorating patient

trolleys

Hyson Green AED Portable oxygen, suction, BVM trolley

Calvary Clinic AED


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Medical Emergency Team Procedure...team or staff member as delegated. 5.5 COMPOSITION OF MET TEAMS...

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Transcript of Medical Emergency Team Procedure...team or staff member as delegated. 5.5 COMPOSITION OF MET TEAMS...