Entrustable Professional Activities

LG11: Resuscitation assessment and management

Learning Goal 11

Resuscitation assessment and management

Resuscitate critically ill / injured paediatric patients

This activity requires the ability to:

  • assess and recognise seriously unwell or injured children
  • recognise clinical deterioration
  • follow the local process for escalation of care
  • manage acutely unwell patients who require resuscitation
  • lead the resuscitation team, and involve other necessary services
  • liaise with transport services and medical teams
  • conduct debriefs with the resuscitation team

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • recognise immediate life-threatening conditions and deteriorating and critically unwell patients, and respond appropriately
  • conduct structured assessments of acutely unwell children
  • follow planned courses of action with appropriate urgency
  • perform advanced neonatal and paediatric life support, according to resuscitation council guidelines, to a high level of advanced resuscitation skills
  • use defibrillators during shockable Advanced Paediatric Life Support (APLS) algorithms and for cardioversion
  • manage compromised airways, using bag valve mask ventilation and basic and advanced techniques
  • obtain intravenous access with standard cannulas and intraosseous devices
  • place central venous lines and arterial lines
  • assess children with traumatic injuries, and prioritise interventions
  • perform finger thoracostomies and intercostal chest drains
  • prescribe resuscitation fluids and blood products
  • prescribe critical medications such as antibiotics, antiepileptics, antivirals, and insulin
  • enact neuroprotective measures for children with head trauma
  • demonstrate knowledge of the potential risks and complications of resuscitation
  • identify critical toxicology emergencies and manage them appropriately, including cardiac arrythmias, hyperthermia, and seizures, and anticipate and respond to complications
  • recognise when it is appropriate to change the focus of care from resuscitation and life preservation to comfort care with dignity
  • develop appropriate post-resuscitation plans

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • recognise seriously unwell patients requiring immediate care
  • initiate paediatric and neonatal resuscitation as indicated
  • adequately manage compromised airways, using bag valve mask ventilation and by using oropharyngeal and nasopharyngeal airways and laryngeal mask airways (LMAs)
  • obtain intravenous access with standard cannulas and intraosseous devices
  • use defibrillators during shockable APLS algorithms
  • re-evaluate patients and their situations with sufficient frequency
  • respond to complications as they arise

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • concisely and clearly communicate all vital information to team members during resuscitation
  • communicate with all members of the paediatric resuscitation team, using closed-loop communication where appropriate
  • establish and communicate clear roles, responsibilities, and priorities within the resuscitation team
  • summarise the clinical evolution of the situation to the resuscitation team
  • communicate with families, whānau, and/or carers of children during resuscitation
  • keep families, whānau, and/or carers informed throughout the resuscitation, if staffing allows
  • allocate a member of staff to conduct hot debriefs with staff members involved with resuscitation

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • communicate sufficiently to support the function of multidisciplinary teams
  • communicate with patients in a timely and appropriate manner

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • maintain up-to-date certification in advanced paediatric life support
  • analyse adverse incidents and sentinel events to identify system failures and contributing factors
  • maintain a safe department while paediatric resuscitation is occurring
  • identify evidence-based practice gaps using clinical indicators, and implement changes to improve patients’ outcomes
  • establish a psychologically safe practice to debrief and catch up a team after a critical incident, such as resuscitation that results in the death of a patient, to support team mental wellbeing and staff retention

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • comply with safety requirements of the health service
  • evaluate the quality of processes through well-designed audits
  • evaluate the quality and safety processes implemented within the workplace, and identify gaps in their structure
  • raise appropriate issues for review at morbidity and mortality meetings

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • actively participate in multidisciplinary practice of resuscitation skills, including simulation where available
  • demonstrate effective supervision skills and teaching methods for junior colleagues around resuscitation skills and knowledge

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • maintain life support requirements of the health service
  • provide constructive feedback to junior colleagues to contribute to improvements in individuals’ skills
  • coordinate and supervise junior colleagues from the emergency department and wards

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • incorporate current evidence-based resuscitation guidelines and protocols
  • consider enrolling eligible patients in approved clinical trials
  • accurately document the resuscitation course to contribute to quality improvement / research

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • use information from credible sources to aid in decision making
  • refer to evidence-based clinical guidelines and protocols on acutely unwell patients
  • demonstrate an understanding of the limitations of the evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • negotiate care decisions in a culturally appropriate way by considering variation in family structures, cultures, religion, or belief systems
  • practise culturally safe care of all patients, with particular focus on Aboriginal and Torres Strait Islander peoples and Māori
  • consider cultural, ethical, and religious values and beliefs in leading multidisciplinary teams
  • identify and respect cultural, religious, and other cultural concerns in end-of-life care

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • practise culturally safe care appropriate for the community serviced
  • proactively identify barriers to healthcare access

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • advise patients of their rights to refuse medical therapy, including life-sustaining treatment
  • consider the consequences of delivering non-beneficial treatment, directing to other care as appropriate
  • consider cases where organ donation may be appropriate, and how this process may occur or may be limited by access to local paediatric intensive care unit services

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • communicate medical management plans as part of multidisciplinary plans
  • establish, where possible, patients’ wishes and preferences about care

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • frequently re-evaluate patients and their situations
  • recognise the need for escalations of care, and escalate to appropriate staff or services
  • use appropriate guidelines, evidence sources, and decision support tools
  • consolidate information given from many members of staff during resuscitations to make informed decisions regarding further treatment and investigations for patients

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • recognise the bounds of their own abilities, and know when and how to seek assistance from departmental colleagues or other specialities

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • lead paediatric resuscitations
  • identify the roles and scopes of practice of health professionals related to resuscitation, and use their expertise appropriately
  • work collaboratively with staff in the emergency department, intensive care, and other subspecialty inpatient units
  • monitor the resuscitation team’s activities, and constructively intervene when needed
  • liaise with other appropriate healthcare providers if patients require transport to another service
  • use resources to allow the ongoing running of a safe emergency department while safely transporting acutely unwell children to other facilities

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • collaborate with other team members, based on their roles and skills
  • deliver appropriate multidisciplinary assessment and management

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • use a considered and rational approach to the responsible use of resources, balancing costs against outcomes
  • prioritise patients’ care based on need, and consider available healthcare resources
  • collaborate with emergency medicine staff and other colleagues to develop policies and protocols for the investigation and management of common acute medical problems
  • follow policies on mandatory reporting
  • advocate for paediatric emergency care resources and policies
  • implement disaster plans and processes

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • apply escalation of care procedures for deteriorating patients
  • use leadership and advocacy in appraising and redesigning systems of care that lead to better patient outcomes