Developed by the NSW Paediatric Palliative Care Programme in conjunction with the NSW Ministry of Health

September 2015

The Resuscitation Plan Paediatric

Outline1. The Resuscitation Plan – paediatric and adult

2. Case Study

3. Background

4. Why a statewide form?

5. Key issues

6. Ordering the Resuscitation Plan

7. Where to get more information?

Statewide Resuscitation Plans

There are 2 Resuscitation Plans available:

• Resuscitation Plan Paediatric: Currently for infants >

28 days old and young persons up to 18 years

(SMR020.055)

• Resuscitation Plan Adult: 18 years and older

(SMR020.056)

Case Study• Sarah is a 9 year old girl with recurrent lower respiratory tract

infections on a background of chronic lung disease and a

neurodegenerative disorder.

• She is deteriorating neurologically with increased muscle

weakness and requires nocturnal BiPap.

• She has had recurrent admissions to hospital with lower

respiratory tract infections.

• She lives 1 hour from the children’s hospital. Large tertiary

hospital within 15 minutes.

• NSW ambulance form in place.

Triggers for considering a Resuscitation Plan- paediatric

• If the treating clinician were to ask, ‘Would I be surprised if Sarah were

to die in 6-12 months?’ and the answer is ‘No’.

• A steady deterioration in chronic illness.

• An increased risk (recurrent admissions and her prognosis is

uncertain).

• Clinical deterioration in her condition would require an activation of a

Rapid Response System, or is anticipated to do so.

• Established goals are identified for end of life care.

• Clear communication is needed for all hospital/community health

providers involved in care.

Resuscitation Plan – Paediatric (SMR020.055)

Resuscitation Plan – Adult (SMR020.056)

BackgroundThe NSW Resuscitation Plan:

• An outcome of the NSW Health Advance Planning for Quality

Care at End of Life: Action Plan 2013-2014.

• A working group was established to review the existing Policy

Guideline Decisions relating to No Cardio-Pulmonary

Resuscitation (CPR) Orders.

• An extensive consultation process was carried out with

relevant NSW health clinicians on draft documents

leading to the final Resuscitation Plans.

Why a Statewide Form?

• Patients are cared for across various health locations in

NSW (hospital, community, ambulance service).

• A statewide form aims to improve communication between

all health providers involved in care by:

Supporting common terminology related to advance

care planning/end of life.

Reducing confusion for health providers.

Improving consistency in End of Life care

documentation.

NSW MOH Policy Directive (PD)• All NSW Public Health Organisations must comply (acute facilities,

sub-acute facilities, ambulatory, community settings, NSW

Ambulance) and implement the Resuscitation Plan.

• All other equivalent forms (no CPR/ End of Life Care Plans) will be

replaced by the Resuscitation Plan.

• NSW Resuscitation Plans are not valid for community patients under

the medical care of a doctor that is not a NSW Health staff member.

• General Practitioners with admitting rights are considered NSW

Health staff.

Key issues for use 1. Evidence of prior planning

• Consider previous documentation (e.g. Allow a Natural Death Form

or Advanced Care Plan).

• Conversations held with parents/carers and patients as appropriate.

2. Capacity and participation

• Attending Medical Officers prescribing medical orders, including

‘Resuscitation Plans’, hold responsibility for reaching those

decisions, in consultation with parents/carers.

• Usually decisions are made by parents/carers (a child will not

always have capacity for decision making).

• When appropriate, decision making with children/young people

can occur in consultation with parents/carers.

• If Family and Community Services (FACS) are involved,

refer to back page of Resuscitation Plan-Paediatrics.

3. Clinical interventions and monitoring

• Vital sign monitoring on the Standard Paediatric Observation

Chart should be consistent with what is stated in the

Resuscitation Plan.

• Nurses may call for medical review of unrelieved symptoms, even

where activating an urgent Clinical Review call has been

considered unnecessary.

4. Referral/transfer/discharge

• NSW Health Resuscitation Plans are valid for NSW Ambulance

staff in all situations involving patient contact.

• Parents/guardians should be provided with a copy of the

document.

• A hard copy of the Resuscitation Plan should accompany the

patient on inter-facility transfer or discharge home.

• Resuscitation Plans are valid in community settings except for

community patients under the medical care of a doctor that is not

a NSW Health staff member. General Practitioners with admitting

rights are considered NSW Health staff.

5. Authorising and signing the Resuscitation Plan

• The Attending Medical Officer (AMO) has medico-legal responsibility for a

patient, even if other medical officers are involved.

• The most experienced clinician should generally discuss resuscitation with

the child’s parent/carer.

• Delegation to a JMO should only occur with adequate training, supervision and

support. If a JMO is required to discuss and document a Resuscitation Plan

(e.g. out of hours) this must be discussed with the AMO at the earliest

opportunity.

• Health care professionals (including nurses) cannot be delegated the task of

informing parents/carers or obtaining consent for resuscitation planning.

When information is requested by the parent/carer, all resuscitation

discussions held should be documented in the medical record.

• Parents/carers are not required to sign the Resuscitation Plan.

6. Reviewing the Resuscitation Plan

• Generally the information on a completed Resuscitation Plan

needs to be clarified from one acute admission to the next (where

a change in prognosis is likely).

• Information on the Resuscitation Plan may need to be checked

more or less frequently for some patients and individual family

circumstances. 

• If parents/carers request a change.

• Refer to the back of the Resuscitation Form for further

information.

7. Revoking or amending the Resuscitation Plan

• For significant amendments (e.g. a change to the CPR order),

the Resuscitation Plan must be revoked and a new Plan

completed. The procedure for revoking the Resuscitation Plan

is to rule a diagonal line through both sides, then print and

sign your name and date on the line.

• For less significant amendments (for example, a change to the

intervention section), the Resuscitation Plan can be amended

and initialled. This should be documented in the medical

record.

• Please refer to the back of the Resuscitation Plan for further

information about amendments required.

8. Storage of Resuscitation Plans

• Each hospital has different processes in place for storing the

Resuscitation Plan.

• It is recommended that the current hard copy should be kept at

the front of the patient’s health record. It is preferable that

multiple copies are not made.

• Details of the Resuscitation Plan should be included in handover

between shifts.

• Must be integrated into electronic health record systems on

appropriate forms.

• Incorporate into hospital discharge summaries, where possible.

How to order the Resuscitation Plan

Forms can be ordered through Stream Solutions:

• Paediatric: (Product Code: NH606747) Resuscitation Plan –

Paediatric (SMR020.055) pack of 20.

• Adult: (Product Code: NH 606746) Resuscitation Plan – Adult

(SMR020.056) pack of 100.

Where to get more information?

• The Resuscitation Plan Policy Directive (PD 2014_030)

http://www0.health.nsw.gov.au/policies/pd/2014/PD2014_030.html• Alternatively please contact one the 3 services representing

The NSW Paediatric Palliative Programme:

The Children’s Hospital at Westmead John Hunter Children’s Hospital, Newcastle Phone: 9845 0000 Phone: 4921 3387 Business hours: 830am-5pm Business hours: 830am-5pm Email: schn-chwppc@health.nsw.gov.au Email: HNELHD-PaedPallCare@hnehealth.nsw.gov.au

Sydney Children’s Hospital, Randwick Phone: 9382 5429 Mobile: 0412 915 089 Business hours: 830am-5pm Email: SCHN-cncpalliativecare@health.nsw.gov.au