The following resuscitation reminders should be reinforced in facility CPR policies, procedures, and training.
It is recommended that 911 be called unless a "Do Not Resuscitate" (DNR) order is written by the resident's physician.
The 2015 American Heart Association Guidelines Update for CPR and ECC (Emergency Cardiac Care) provide the following advice regarding "Shock First vs CPR First":
"For witnessed adult cardiac arrest when an AED is immediately available, it is reasonable that the defibrillator be used as soon as possible. For adults with unmonitored cardiac arrest or for whom an AED is not immediately available, it is reasonable that CPR be initiated while the defibrillator equipment is being retrieved and applied and that defibrillation, if indicated, be attempted as soon as the device is ready for use."
It is also recommended that nursing facility CPR efforts should not cease until:
- an obvious sign of life, such as breathing, is observed,
- an AED is available and ready to use,
- EMTs provide relief, or
- a physician orders that efforts be terminated.
Further, it is important that the facility establish and use a mechanism to quickly identify a resident's choice for a DNR (Do Not Resuscitate) or full code. Some facilities have an indicator on the resident's armband while others have a designation placed in the resident's room. Regardless of the method, care should be taken to safeguard resident confidentiality.
There are many other parameters/guidelines for CPR, and we share the following links as additional references:
https://www.practicalbioethics.org/files/resuscitation/Zweig_14_1.pdf
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf(Surveyor guidelines referencing CPR in nursing facilities start on page 18)
https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/
Any questions or comments regarding the above should be directed to the Division of Provider Services, Bureau of Quality and Provider Management at 877-299-2918.
A listserv has been established for ongoing updates on the CHC program. It is titled OLTL-COMMUNITY-HEALTHCHOICES, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.
Please share this email with other members of your organization as appropriate. Also, it is imperative that you notify the Office of Long-Term Living for changes that would affect your provider file, such as addresses and telephone numbers. Mail to/pay to addresses, email addresses, and phone numbers may be updated electronically through ePEAP, which can be accessed through the PROMISe provider portal. For any other provider file changes please notify the Bureau of Quality and Provider Management Enrollment and Certification Section at 1-800-932-0939 Option #1.
To ensure you receive email communications distributed from the Office of Long-Term Living, please visit the ListServ Archives page athttp://listserv.dpw.state.pa.us to update or register your email address.
