Procedure Version 7.0
CCID371874
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
Page 1 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
Procedure Version 7.0
CCID371874
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
Page 2 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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)
Procedure Version 7.0
CCID371874
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
Page 3 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 4 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 5 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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.
Procedure Version 7.0
CCID371874
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
Page 6 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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.
Procedure Version 7.0
CCID371874
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
Page 7 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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.
Procedure Version 7.0
CCID371874
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
Page 8 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 9 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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.
Procedure Version 7.0
CCID371874
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
Page 10 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 11 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 12 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 13 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 14 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 15 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 16 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 17 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 18 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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)
Procedure Version 7.0
CCID371874
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
Page 19 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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)
Procedure Version 7.0
CCID371874
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
Page 20 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 21 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 22 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 23 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 24 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 25 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 26 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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
Procedure Version 7.0
CCID371874
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
Page 27 of 27 Continuing the Mission of the Sisters of the Little Company of Mary
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