Quality Standards: Acute care equipment and drug lists

Quality Standards: Acute care equipment and drug listsAuthorsResuscitation Council UKoriginally published November 2013. Last updated May 2020.

Introduction

Healthcare organisations have an obligation to provide a high-qualityresuscitation service, and to ensure that staff are trained and updated regularlyto a level of proficiency appropriate to each individual’s expected role.

As part of the quality standards for cardiopulmonary resuscitation practice andtraining this document provides lists of the minimum equipment and drugsrequired for cardiopulmonary resuscitation. These lists are categorised accordingto the clinical setting.

The equipment and drug lists on this page are in reference to the Acute Care Quality Standards.

The core standards for the provision of cardiopulmonary resuscitation across allhealthcare settings are described in the Introduction and Overview to Quality Standards.

Drug tables for cardiac arrest are highlighted in the text with the symbol !

General points

1. All clinical service providers must ensure that their staff have immediateaccess to appropriate resuscitation equipment and drugs to facilitate rapidresuscitation of the patient in cardiorespiratory arrest. The standarddefibrillator sign should be used in order to reduce delay in locating a

https://www.resus.org.uk/library/quality-standards-cpr/acute-care-equipment-and-drug-lists

https://www.resus.org.uk/library/quality-standards-cpr/quality-standards-acute-care


https://www.resus.org.uk/library/quality-standards-cpr/introduction-and-overview

https://www.resus.org.uk/library/quality-standards-cpr/introduction-and-overview

defibrillator in an emergency. The sign can be downloaded here.2. All settings must have a means of calling for help (e.g. landline telephone

[internal or external], mobile telephone with reliable signal, or alarm bell).3. Standardisation of the equipment used for cardiopulmonary resuscitation

(including defibrillators and emergency suction equipment), and the layoutof equipment and drugs throughout an organisation is recommended.

4. It is recognised that planning for every eventuality is complex; therefore,organisations must undertake a risk assessment to determine whatresources are required given their local circumstances. Risk factors toconsider include patient group (e.g. adults, children), incidence of cardiacarrest, training of staff, and access to expert help.

a. For example, in secondary or tertiary care specific locations mayneed special provisions (e.g. for failed intubation, tracheostomy care,cardiac arrest in pregnancy etc).b. Some settings need a wide range of equipment immediatelyavailable (e.g. resuscitation room in emergency department).Suggested options include having basic equipment (and possiblydrugs) available immediately (on a resuscitation trolley), and furtherequipment and drugs arriving with a resuscitation team (in a ‘grab-bag’), or in some settings as part of an ambulance response.c. Staff should be trained to use the available equipment according totheir expected roles.

5. Depending on the organisation, this risk assessment must be overseen by aResuscitation Committee or a designated resuscitation lead. Expert adviceshould also be sought locally from those commonly involved in resuscitation(e.g. resuscitation officers, emergency physicians, cardiac care unit staff,intensivists, anaesthetists, prehospital care physicians).

6. Resuscitation equipment should be single-patient-use and latex-free,whenever possible and appropriate. Where non-disposable equipment isused, a clear policy for decontamination after each use must be availableand must be followed.

7. Personal protective equipment (e.g. gloves, aprons, eye protection) andsharps boxes must be available, based on a local risk assessment and localpolices.

8. A reliable system of equipment checks and replacement must be in place toensure that equipment and drugs are always available for use in a cardiacarrest. The frequency of checks should be determined locally.

9. It is recommended that equipment and drugs are presented in a clear andlogical manner to enable easier use during an emergency.

10. The manufacturer’s instructions must be followed regarding use, storage,

https://www.resus.org.uk/library/additional-guidance/guidance-defibrillators/guidance-standard-sign

servicing and expiry of equipment and drugs.11. Further equipment and drugs may be needed to manage other types of

emergencies that are likely to be encountered in a particular setting; thismay include:

monitoring equipment (e.g. blood pressure, pulse oximetry, 3-leadelectrocardiogram [ECG], temperature, waveform capnography),12-lead ECG recorder,difficult airway equipment (e.g. scalpel and bougie forcricothyroidotomy),near-patient tests (e.g. blood glucose, blood gas analysis).

12. A formal procurement process that includes trialling of equipment beforepurchase is recommended. Trialling of resuscitation equipment can takeplace in actual care settings or in simulated clinical scenarios.

13. The precise availability of equipment and drugs should be determinedlocally. The equipment lists include a suggestion on the immediacy withwhich equipment and drugs should be available:

a. Immediate - available for use within the first minutes ofcardiorespiratory arrest (i.e. at the start of resuscitation).b. Accessible - available for prompt use when the need is determinedby resuscitation team.

14. These lists are not exhaustive. Local experts should be consulted to ensurethat the appropriate equipment and drugs are available when they areneeded, to enable provision of high-quality attempted resuscitation.

Equipment and drug lists: adult

The equipment and drug lists in this chapter are for adult acute hospital care.


Airway and Breathing (Adult)

Acute Hospital Care - Adult

Airway and breathing

Item SuggestedAvailability Comments

Pocket mask withoxygen port Immediate According to

local policy

Oxygen maskwith reservoir Immediate

Self-inflating bagwith reservoir Immediate

Clear facemasks, sizes 3, 4,5

Immediate

Oropharyngealairways, sizes 2,3, 4

Immediate

Nasopharyngealairways, sizes 6,7 (andlubrication)

Immediate

Portable suction(battery ormanual) withYankauer suckerand soft suctioncatheters

Immediate

Airway suctionequipment.NPSA Signal.Referencenumber 1309.February 2011

Supraglotticairway devicewith syringes,lubrication andties/tapes/scissorsas appropriate

Immediate/Accessible

Choice ofdevice (e.g.laryngeal maskairway, i-gel®,laryngeal tube)and size willdepend on localpolicy and stafftraining


Oxygen cylinder(with key wherenecessary)

Immediate

Oxygen tubing Immediate

Magill forceps Immediate

Stethoscope Immediate

Tracheal tubes,cuffed, sizes 6, 7,8


This will dependon local policyand stafftraining. Forexample, thereis notconsensus onthe role of a‘stylet’

Tracheal tubeintroducer(stylet)




Laryngoscopehandles (x 2) andblades (size 3and4)

Spare batteriesfor laryngoscopeand spare bulbs(if applicable)



Syringes,lubrication andties/tapes/scissorsfor tracheal tube




Waveformcapnograph -withappropriatetubing andconnector


For use withsupraglotticairways ortracheal tube.NAP4 - 4thNational AuditProject of theRoyal College ofAnaesthetistsand the DifficultAirway Society,March 2011.

Standards of monitoring during anaesthesia and recovery.Association ofAnaesthetist ofGreat Britainand Ireland,2011.

EBA Recommendation for the use of Capnography. European BoardofAnaesthesiology,2011.

Circulation (Adult)

https://anaesthetists.org/Home/Resources-publications/Guidelines/Standards-of-monitoring-during-anaesthesia-and-recovery





http://www.eba-uems.eu/resources/PDFS/safety-guidelines/EBA-UEMS-recommendation-for-use-of-Capnography.pdf





Circulation

Item Suggestedavailability Comments

DefibrillatorManual and/orautomated externaldefibrillatorPacing function ifneeded

Immediate

Type ofdefibrillator,andlocationsdetermined byalocal riskassessment.Available toenable shockwithin 3minutesofcollapse.Pacingfunction isrecommendedfor cardiacunits,cardiaccatheterlaboratories,emergencydepartments,intensive careunits andoperatingtheatres. It mayalso beappropriate forother settings,and this shouldbe determinedlocally

Adhesivedefibrillator pads Immediate

Spare set ofpads alsorecommended.Pads should besuitable forexternal pacingif needed

Razor Immediate

ECG electrodes Immediate

Intravenouscannulae (selectionof sizes) and 2%chlorhexidine/alcoholwipes, tourniquetsand cannuladressings


Adhesive tape Immediate/Accessible

Intravenous infusionset Immediate/Accessible

0.9% sodiumchloride (1000 ml) Immediate/Accessible

Amountdepends onavailability offurther supplies

Selection of needlesand syringes Immediate/Accessible

Intra-osseousaccess device Accessible

Central venousaccess - Seldingerkit, full barrierprecautions (hat,mask, sterile gloves,gown) and skinpreparation (2%chlorhexidine /alcohol)

Accessible

Placed withultrasoundguidance,where possible

Ultrasound /echocardiography Accessible

To identify andtreat reversiblecauses ofcardiorespiratoryarrest

Other Items (Adult)


Other items


Clock/timer Accessible

Gloves, aprons,eye protection Immediate

Furtherpersonalprotectiveequipmentmay berequiredaccording tolocal policy

Nasogastric tube Accessible

Sharps containerand clinical wastebag

Immediate

Sharpscontainermust beimmediatelyavailablewhereversharps used

Large scissors Accessible

2% chlorhexidine/ alcohol wipes Accessible

Blood sampletubes Accessible

IV extension set Accessible

Types ofconnectors,ports, andcaps to bedeterminedlocally

Pressure bags forinfusion Accessible


Blood gas syringe Accessible

Blood glucoseanalyser withappropriate strips

Immediate/Accessible According tolocal policy

Drug labels Accessible

Guidance oncolourcoding forsyringelabels

Manual handlingequipment Accessible

According tosetting. See Guidance for safer handling during resuscitationin healthcare settings

Cardiorespiratoryarrest recordforms for patientrecords, auditforms andDNACPR forms

Accessible

Access toalgorithms,emergency drugdoses

Accessible

CARDIAC ARREST DRUGS - FIRST LINE for intravenous use !

https://www.resus.org.uk/library/publications/publication-guidance-safer-handling








(Adult)




Adrenaline 1mg(= 10 ml1:10,000) as aprefilled syringex 3

Immediate

Number of syringesdepends on accessto further syringes.1mg needed foreach 4-5 min of CPR

Amiodarone300mg as aprefilled syringex 1

AccessibleFirst dose requiredafter 3 defibrillationattempts

CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use ! (Adult)


CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use !


Adenosine 6mgx 5 Accessible

Atropine - 1mgx 3 Accessible

Adrenaline1mg(= 10 ml1:10,000)prefilledsyringe

Accessible

Furthersyringesshould beaccessible forprolongedresuscitationattempts

Amiodarone300mg x 1 Accessible

If decision ismade to givefurther dosesof amiodarone

Calciumchloride 10 ml10% x 1

Accessible

Calciumgluconate canbe used as analternative.Note: 10 ml 10%Calciumchloride = 6.8 mmol Ca2+10 ml 10%Calciumgluconate =2.26 mmolCa2+


Chlorphenamine10 mg x 2 Accessible

Second-linetreatment foranaphylaxis,can also begivenintramuscularly

Hydrocortisone100 mg x 2 Accessible

Second-linetreatment foranaphylaxis,can also begivenintramuscularly

Glucose forintravenoususe


Volume andconcentrationaccording tolocal policy

20% lipidemulsion 500ml

Accessible

For use inareas wherelarge doses oflocalanaestheticare used forregionalblocks,according toAssociation ofAnaesthetistsGuidelines.

Lidocaine 100mg x 1 Accessible

Inclusion to bedeterminedlocally


Magnesiumsulphate (2 g =8 mmol) x 1

Accessible

Midazolam 5mg in 5 ml x 1 Accessible NPSA Alert

Naloxone 400microgram x 5 Accessible

Potassiumchloride Accessible

Formulation tobe determinedlocally.

Potassiumchlorideconcentratesolutions.Patient safetyalert. TheNationalPatient SafetyAgency. July2002.

Sodiumbicarbonate8.4% or 1.26%

Accessible

Volume andconcentrationaccording tolocal policy

Other drugs (Adult)


Other drugs


Adrenaline 1mg(1ml 1:1000) Immediate

First-line treatmentfor anaphylaxis - 0.5mg intramuscularinjection in adults

Aspirin 300 mgand otherantithromboticagents

AccessibleFor acute coronarysyndrome accordingto local policy

Furosemide 50mgIV x 2 Accessible

Flumazenil 0.5mgIV x 2 Accessible

Glucagon 1 mg IVx 1 Accessible

GTN spray Accessible

Ipratropiumbromide 500microgramnebules x 2 (andnebuliser device)

Accessible

Salbutamol 5mgnebules x 2 (andnebuliser device)and IVpreparationforinfusion

Accessible

0.9% sodiumchloride orHartmann’ssolution 1000 mlx2 cooled to 4°C

Accessible

For induction oftherapeutichypothermia as partof post-cardiorespiratoryarrest care

Notes and supporting information (Adult)

Notes

1. Portable monitoring and other equipment for patient transfer should bereadily available.

2. Further drugs for post-cardiac-arrest care (e.g. inotropes, vasopressors,anaesthetic agents, antibiotics) should be available readily, according tolocal critical care policies.

3. Keeping resuscitation drugs locked away - this problem was addressed indetail in 2005 by the Royal Pharmaceutical Society of Great Britain in arevision of the Duthie Report (1988) ‘The Safe and Secure Handling ofMedicines’. Resuscitation Council UK responded with a statement, alongwith an accompanying letter written to the CQC explaining the position.

Supporting information

1. Association of Anaesthetists of Great Britain and Ireland (AAGBI) SafetyGuideline - Interhospital Transfer. 2009. http://www.aagbi.org

2. Intensive Care Society. Guidelines for the Transport of the Critically Ill Adult(3rd Edition 2011). http://www.ics.ac.uk

3. The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus https://www.diabetes.org.uk/Documents/About%20Us/Our%20views/Care%20recs/JBDS%20hypoglycaemia%20position%20(2013).pdf

Equipment and drug lists: paediatric

The equipment and drug lists in this chapter are for paediatric acute hospitalcare.


Airway and Breathing (Paediatric)

https://www.resus.org.uk/about-us/news-and-events/statement-keeping-resuscitation-drugs-locked-away

http://www.aagbi.org

http://www.ics.ac.uk

https://www.diabetes.org.uk/Documents/About Us/Our views/Care recs/JBDS hypoglycaemia position (2013).pdf

https://www.diabetes.org.uk/Documents/About Us/Our views/Care recs/JBDS hypoglycaemia position (2013).pdf

Acute Hospital Care - Paediatric

Airway and breathing


Pocket mask withoxygen port -paediatric and adult

Immediate According tolocal policy

Oxygen mask withreservoir - paediatricand adult

Immediate

Self-inflating bag withreservoir - paediatricand adult

Immediate

Clear face masks, size00, 0, 1, 2, 3, 4, 5 Immediate

Oropharyngealairways, sizes 00, 0,1,2, 3, 4

Immediate

Nasopharyngealairways, sizes 4.0,4.5,5.0, 5.5, 6.0, 7.0(andlubrication)

Immediate

Uncuffedtracheal tubes ofappropriatelength may beused as analternativeaccording tolocalpolicy

Portable suction(battery or manual)with Yankauer sucker(paediatric and adult)and soft suctioncatheters, sizes 5, 6,8, 10, 12, 14

Immediate

Oxygen cylinder (withkey if necessary) Immediate


Oxygen tubing Immediate

Magill forceps (adultand paediatric sizes) Immediate

Stethoscope Immediate

Supraglottic airwaydevice with syringes,lubrication andties/tapes/scissors asappropriate

Accessible

Choice of deviceand size willdepend on localpolicy and stafftraining

Tracheal tubes,uncuffed sizes 2, 2.5,3, 3.5, 4, 4.5, 5, 5.5, 6

Accessible

Cuffedpaediatric tubesaccording tolocal policy

Tracheal tubes, cuffedsizes 6, 7, 8, Accessible

Croup tube (uncuffed,longer than standardtracheal tube), sizes2, 2.5, 3, 3.5

Accessible

Alternativedevices may besubstitutedaccording tolocal policy (e.g.Cole's® tubes)

Tracheal tubeintroducer (stylet)small and medium

Accessible

Intubating bougie - 5Ch & 10 Ch Accessible


Laryngoscope handles(x 2) and blades(sizes-straight 0, 1,curved2, 3, 4)Spare batteries forlaryngoscope andspare bulbs (ifapplicable)

Accessible

Syringes, lubricationand ties/tapes (e.g.Elastoplast® / Hypofix® /ribbon gauze/tape)and scissors

Accessible

Waveformcapnograph - withappropriate tubingand connector(battery-operated)

Accessible

NAP4 - 4thNational AuditProject of theRoyal College ofAnaesthetistsand the DifficultAirway Society,March 2011

Circulation (Paediatric)


Circulation


Defibrillator- Manual and/orautomatedexternaldefibrillator (AED)

Immediate

Type of defibrillator andlocations decided by a localrisk assessment. AEDs are notintended for use in infants(less than 12 months old) andthis should be considered atrisk assessment

Availability of pacing functionaccording to local policy

Adhesivedefibrillator pads -paediatric andadult sizes

Immediate

Spare set of pads alsorecommended. Pads shouldbe suitable for externalpacing if needed

ECG electrodes(paediatric &adult sizes)

Accessible

Intravenouscannulae (sizes14, 16, 18, 20,22, 24G) and 2%chlorhexidine /alcohol wipes,tourniquets anddressings

Immediate

Adhesive tape Immediate

Intravenousinfusion sets(with and withoutincorporatedburette)

Accessible


IV extension setwith 3-way tapsand bungs

Accessible

0.9% sodiumchloride¹ Accessible Amount depends on access to

further fluids

10% Dextrose¹ Accessible

Selection ofneedles andsyringes

Immediate

Intra-osseousaccess devicewith needlessuitable forneonates,children andadults

Immediate

Colloid solutionfor IV infusion¹ Accessible According to local policy

Central venousaccess -Seldinger kit, fullbarrierprecautions (hat,mask, sterilegloves, gown)and skinpreparation (2%chlorhexidine /alcohol)

Immediate

Sizes and type according tolocal policy. Placed withultrasound guidance, wherepossible


Ultrasound /echocardiography Immediate

To identify and treatreversiblecauses ofcardiorespiratoryarrest

Other items (Paediatric)


Other items


Clock / timer Accessible

Gloves, aprons,eye protection Immediate

Urinary catheter,sizes 6-14 Accessible

Nasogastric tube,sizes 6-14 Accessible

Sharps containerand clinical wastebag

Immediate

Sharpscontainermust beimmediatelyavailablewhereversharps areused

Large scissors Accessible

2% chlorhexidine/alcohol wipes Accessible

Blood sampletubes Accessible

Pressure bags forinfusion Accessible

Blood gas syringe Accessible

Blood glucosemonitor withappropriate strips



Drug labels Accessible Guidance onsyringelabels

Manual handlingequipment Accessible

According tosetting. See Guidance for safer handling during resuscitationin healthcare settings

Cardiorespiratoryarrest recordform for patientrecords and auditforms. DNACPRformsappropriate forchildren.

Accessible

Access toalgorithms,emergency drugdoses, paediatricdrug dosecalculators (e.g.Broselow tape)

Immediate According tolocal policy

CARDIAC ARREST DRUGS - FIRST LINE for intravenous use ! (Paediatric)












Adrenaline 1mg(= 10 ml1:10,000)prefilledsyringe(s)¹

Immediate

Number of syringesdepends on ease ofaccess to furthersyringes if needed

Amiodarone300mg prefilledsyringe(s)¹

Accessible

CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use ! (Paediatric)


CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use !


Adenosine 6 mg¹ Accessible

Atropine 1mg¹ AccessibleALERT: Atropine isavailable in variousconcentrations

Adrenaline 1mg(= 10 ml1:10,000)

Accessible

Amiodarone300mg¹ Accessible

Calcium chloride10 ml 10%¹ Accessible

Calcium gluconatemay be used as analternative. Note:10 ml 10% Calciumchloride = 6.8 mmolCa2+10 ml 10% Calciumgluconate = 2.26mmol Ca2+

Chlorphenamine10 mg¹ Accessible

Second-linetreatment foranaphylaxis, canalso giveintramuscular

Diazepam and/orLorazepam Accessible

For treatment ofstatus epilepticus.Agent, dose androute ofadministrationaccording to localpolicy


Hydrocortisone100 mg¹ Accessible

Second-linetreatment foranaphylaxis, canalsobe givenintramuscularly

Glucose¹ AccessibleConcentrationaccording to localpolicy

20% Lipidemulsion¹ Accessible For local anaesthetic

toxicity

Lidocaine 100mg¹ Accessible

Magnesiumsulfate (2 g = 8mmol)¹

Accessible

Midazolam 5 mgin 5 ml¹ Accessible NPSA Alert

Morphine¹ Accessible According to localpolicy

Naloxone 400microgram¹ Accessible

Potassiumchloride¹ Accessible

Potassium chlorideconcentratesolutions. Patientsafety alert. TheNational PatientSafety Agency. July2002.


Sodiumbicarbonate 8.4%or 1.26%¹

Accessible

Concentration andpreparationaccording to localpolicy

OTHER EMERGENCY DRUGS (Paediatric)


OTHER EMERGENCY DRUGS


Adrenaline1mg(1 ml1:1000)¹ Immediate

First-line treatment foranaphylaxis.Can be part of an‘anaphylaxis kit’ sothat it is not mixed /confused withcardiorespiratoryarrestdrugs

Furosemide 50mg IV¹ Accessible

Flumazenil 0.5mg IV¹ Accessible

Glucagon 1 mgIV¹ Accessible

Ipratropiumbromide 500microgramnebules (andnebuliserdevice)¹

Accessible

Salbutamol5mg nebules(and nebuliserdevice)¹

Accessible

Salbutamol1mg/ml for IVinfusion¹

Accessible

Notes (Paediatric)

1. The volume and/or quantities of the listed fluids and drugs stored and their

location should be determined by local policy. This should ensure that thereis sufficient availability to manage a paediatric resuscitation according toResuscitation Council UK resuscitation guidelines without undue delay.

2. Portable monitoring and other equipment for patient transfer should bereadily available.

3. Further drugs for post-cardiac-arrest care (e.g. inotropes, vasopressors,anaesthetic agents, antibiotics) should be readily available according tolocal critical care policies.

4. All interventions (e.g. drug therapy, practical procedures, discussions withother staff or relatives) should be documented with date and time andsigned by an identifiable member of staff.

5. Keeping resuscitation drugs locked away - this problem was addressed indetail in 2005 by the Royal Pharmaceutical Society of Great Britain in arevision of the Duthie Report (1988) ‘The Safe and Secure Handling ofMedicines’. Resuscitation Council UK responded with a statement, alongwith an accompanying letter written to the CQC explaining the position.

Related contentQuality Standards: Acute CareTraining Courses

https://www.resus.org.uk/about-us/news-and-events/statement-keeping-resuscitation-drugs-locked-away


https://www.resus.org.uk/training-courses