Resuscitation in mental health and learning disability settings

This Rapid Response Report is aimed at healthcare organisations providing inpatient care for mental health (MH) and learning disability (LD) patients. It requires them to make proper provision for life support and resuscitation for these patients.

These patients can be vulnerable to cardiac or respiratory arrest through coexisting physical illness, self-harm, and the effects of medication, including rapid tranquilisation. They are also vulnerable to choking from a variety of causes.

An analysis of National Reporting and Learning Service data has revealed 599 reports of at least moderate harm related to choking or cardiac or respiratory arrest in MH and LD settings. These demonstrated wide variations in standards of resuscitation.

Of these incidents, 26 described significant lack of staff knowledge, skills, or equipment. Three patient deaths occurred after choking on food. Another 22 reports were of moderate or severe harm following choking.

Healthcare organisations should ensure that:

1. Basic life support (BLS) training is based on Resuscitation Council (UK) standards, including the management of choking.
2. Patient areas have immediate access to BLS equipment, and automated external defibrillators where appropriate.
3. Units where rapid tranquilisation, physical intervention, or seclusion may be used have access to staff trained in immediate life support and equipment.
4. Training includes regular practices where feasible.
5. They identify a leadership role for resuscitation issues. They should also audit and report on life-support training attendance, and act on any lapses.