FAQ - Rural and Remote Emergency Services Standardisation - Rural and Remote Clinical Support Unit (RRCSU)
The standardisation is specifically designed for all rural and remote facilities which are required to provide emergency services to their catchment community and the emergency service has been assessed as being Level 1 or Level 2 under the Clinical Services Capability Framework for Public and Licensed Private Health Facilities version 3.1.
This will ideally include over 130 facilities across the entire state.
Although the standardisation is initially aimed at these target emergency services, other resuscitation trolleys in these facilities will also be standardised. Facilities with higher clinical services capability may also implement if they wish.
The cohort of rural and remote facilities with Clinical Services Capability Framework for Public and Licensed Private Health Facilities version 3.1 Level 1 and Level 2 emergency services encompasses a range of facilities with differing features in terms of size, staffing, location, available support services, patient transfer options, patient transfer times to higher level facilities and clinical capabilities in other areas. The standardisation is designed to suit all facilities within this range.
If issues arise with implementation and maintenance of standardisation, advice can be sought regarding possible solutions from the Rural and Remote Clinical Support Unit, Cairns at RRCSUCairns@health.qld.gov.au.
If you have received a new set of drawers and have not fitted them yet, the proper sequence to fit them (from top to bottom of the trolley) is as follows:
|First & second line drugs|
Information for retro-fitting new drawers to an older trolley should have been made available with the drawers. If this is not the case, please contact the Rural and Remote Clinical Support Unit, Cairns (RRCSUCairns@health.qld.gov.au) for advice.
If an older or unsuitable trolley has been displaced by the new model, it is recommended that this is made known to other hospitals or departments within your Hospital and Health Service. Maybe some other area can use the old trolley.
If you have received a new set of drawers, and the previous set has been displaced, then unfortunately there are no suggestions available about what to do with the old ones. They may be handy for organising small items in a store room. There is really no possibility of a need arising to fit them to another trolley.
During the conduct of the standardisation project, it came to light that there had been instances where accreditation processes had commented unfavourably regarding the storage of drugs (particularly S4 drugs) on Emergency/Resuscitation trolleys.
The project team and Reference Group investigated the locking of trolleys with padlocks, but this was deemed unsuitable in many instances as the trolleys that are recommended by the Project Reference Group have a locking mechanism which locks the entire trolley. If the person with the trolley key is not immediately available, this will restrict the access of any other staff not only to the drugs, but to all emergency response equipment - which could have dire consequences. In the rural and remote context, and especially the smaller facilities where staff numbers are generally low and emergency responses are generally nurse-led, this poses patient safety issues.
In light of this, the project proposed a set of scenarios to address this issue including:
- Trolleys may remain unlocked - to enable timely emergency response without obstacles.
- Where trolleys remain unlocked, there is restricted access to emergency areas to include only Medical and nursing staff - RNs and ENs.
- This restricted access is to be advised to the public by signage e.g. "No public access" at the entrance(s) to the emergency room(s)/area(s).
- Where a trolley is located in the emergency area but may be taken to respond to resuscitation requirements in inpatient areas, the trolley must be accompanied at all times by Medical and/or nursing staff - RNs and ENs.
These conditions were deemed by the Drugs and Poisons Policy and Regulation Unit, Environmental Health Branch to meet the requirements of the Health (Drugs and Poisons) Regulations 1996 by ensuring that the drugs are not accessible by the public and limited to those who are able to have access under the legislation.
The project would suggest that this be the minimum standard and that if facilities wish to lock their trolleys and find this workable, then this is to be encouraged.
Plastic tabs can also be purchased to “lock” the standard trolley. Although the fitting of these tabs may potentially reduce the requirement for checking all of the trolley contents if the tab remains intact, facilities should be aware that the tabs do not require a key and can easily be removed and therefore do not really “lock” the trolley contents.
Many facilities will need to acquire some items on the lists, especially for the procedural kits, which may be a new concept in many facilities. Most items can be obtained through QHSSP Supply Services, Pharmacy or Pathology, using normal ordering processes.
The standardisation project has worked hard with Supply Services to try to identify the description and FAMMIS material number for items that will satisfy the standardisation. These are available from this site. The items identified may not be the only items available in the Supply Services catalogue that will meet the requirements of standardisation, so there may be some minor variation between centres.
The list provided will also change over time with new supply contracts, but the information provided was valid in December 2011.
Units of issue may be larger than required for some items. Following discussion with Supply Services, it is a major undertaking to change units of issue for so many items across a number of distribution centres. It is recommended that local arrangements within Hospital and Health Services be established to cope with this issue e.g. ordering as a group of facilities or ordering through larger facilities.
Audits of the standardisation should not be an onerous task for facility staff or for Hospital and Health Service quality checks.
It is best practice to ensure on (at least) a daily basis that all equipment on the resuscitation trolley is available and operational. These checks should always be recorded, including the identification of the person responsible for the check. A suggested checklist format for both the procedural kits and the resuscitation trolleys have been provided with the Guidelines on this site.
As part of the standardisation project, standardised documentation of emergency presentations was considered. Many rural and remote facilities have been using the Rural Emergency Flow Sheet, many facilities used an amended version of the flow sheet, and others used different forms from various other sources.
A revised design for a Rural and Remote Presentation Record was one of the outcomes of the standardisation project, however, due to the alignment of this initiative with other related initiatives and with the need to include observations to identify the deteriorating patient, the trial of a draft and final development of the form has now been taken up by the Patient Safety and Quality Improvement Service. Further information will be made available in due course.
First and second line drugs are stored in the bottom drawer while the resuscitation trolley is not in use. This has the potential to cause difficulty in access during an emergency, however it is easier to relocate the drugs in an emergency than to relocate equipment currently held in the top drawers for ease of access.
Therefore, it is recommended that the drugs be stored in a container of appropriate size within the drawer and which can be lifted out of the drawer to be more accessible during an emergency.
The only way a standardisation will produce the desired benefits to patient safety is if all facilities observe and implement the guidelines. It is accepted that a small number of items can be added to the lists, but it is strongly recommended that nothing should be removed.
Contact the Rural and Remote Clinical Support Unit, Cairns at RRCSUCairns@health.qld.gov.au.