Why should a nursing assistant not perform CPR if she is not trained to do so

An experienced nurse has received a 24-month caution after failing to give cardiopulmonary resuscitation to a care home patient “who was almost cold” when she arrived on the scene.

A Nursing and Midwifery Council conduct and competence committee issued the caution last month, after a hearing concluded that she had been at fault during the incident.

“A caution order may be appropriate where the case is at the lower end of impaired fitness to practise”

NMC case notes

Jane Frances Kendall admitted that her fitness to practise was impaired as a result of her misconduct for failing to attempt CPR or ensure that emergency services were contacted.

The incident occurred on 26 November 2014 at Moorland Nursing Home in Poulton-le-Fylde, Lancashire, where Ms Kendall was employed.

According to the NMC case notes, a resident was found to be unresponsive by a care assistant, who called Ms Kendall to attend, as she was the nurse in charge at the home on the date of the incident.

When Ms Kendall attended, she found the resident to be “waxy, yellow and almost cold”, NMC the case notes said.

They added that Ms Kendall stated that the “resident was not breathing and having checked the resident, found that there was no pulse or vital signs of life”.

The regulator noted that Ms Kendall admitted that she subsequently failed to attempt CPR or call the emergency services.

The resident did not have a DNAR (Do Not Attempt Resuscitation order) in place and was in fact, certified dead later that day by paramedics, said the NMC.

“When Ms Kendall attended, she found the resident to be ‘waxy, yellow and almost cold’”

NMC case notes

A subsequent police investigation concluded there was nothing suspicious about the resident’s death and the coroner determined that, while it was unexpected, she died from natural causes.

Ms Kendall had worked for the home since 2007 and had extensive nursing experience, having joined the register in 1973. She was also in charge of the home when its manager was not on shift.

Following the incident, the home conducted an internal investigation and Ms Kendall was suspended. The home later lifted the suspension and issued her with a final written warning.

Ms Kendall said she admitted that her standard of care on that occasion, fell short of what would be expected of a registered nurse in those particular circumstances.

She admitted that, although she considered the resident had already died, as no DNAR was in place and the resident’s death was unexpected, she was under an obligation to attempt CPR and to call for emergency assistance.

Furthermore, she admitted that she was acting outside of her competence on the occasion in question and was not qualified to certify death.

In a letter to the NMC, Ms Kendall said she had reflected since the incident and that, faced with a similar situation, she would conduct CPR and would call the emergency services.

“The resident did not have a DNAR in place and was in fact, certified dead later that day by paramedics”

NMC case notes

Ms Kendall further stated that she was “very remorseful regarding the incident and reiterates the steps that she would take, faced with a similar situation”, said the NMC case notes.

In addition, the NMC acknowledged that Ms Kendall had undertaken re-training to address the deficiencies in her practice and to update her knowledge.

It also highlighted that she was still worked at the home where the incident occurred and that her employers had no concerns and felt she was a good employee, who worked in line with her job description.

The NMC concluded that, although Ms Kendall had been working without further concern since the incident, there was a small risk of repetition in the case, though there had not been once as yet.

“The appropriate sanction in this case, therefore, is a caution order for a period of 24 months,” said the regulator.

“The indicative sanctions guidance states that a caution order may be appropriate where the case is at the lower end of impaired fitness to practise and the panel wish to mark the registrant’s behaviour as unacceptable and should not happen again,” it added.

When someone is unresponsive, their tongue can fall backwards and block their airway. Tilting their head backwards opens the airway by pulling the tongue forward.

What should I do if I hear noisy or irregular breathing?

Sometimes when a person is unresponsive their breathing may become noisy or irregular, or they may be gasping. This is usually a sign that their heart is not working properly and you should start chest compressions.

What should I do if I’m on my own when I find someone unresponsive and not breathing?

If you are on your own, call 999 before you start chest compressions.

What are chest compressions?

Chest compressions are where you place your hands in the centre of the chest and repeatedly press downwards and release at a regular rate to help pump the blood around the body.

How long should I do chest compressions for?

Keep going until help arrives. If there is someone else who can help, change over every minute or two. Try to keep doing chest compressions with as little interruption as possible when you change over.

If I press too hard during chest compressions, could I break their ribs?

You might, but try not to worry. Your priority is to keep the blood circulating. A damaged rib will mend, but if you don’t do chest compressions their chances of survival are much lower.

Should I do chest compressions differently on a child or baby?

Yes, chest compressions should be done slightly differently for children or for babies. For a child over one, use only one hand to do chest compressions. For a baby under a year old, use two fingers to do chest compressions.

Find out:

• how to help a baby who is unresponsive and not breathing.
• how to help a child who is unresponsive and not breathing.

What if I make a mistake and do chest compressions but the person is still breathing?

It’s not ideal but don’t worry. There’s no evidence to suggest you will cause any serious damage.

Am I supposed to give rescue breaths too?

If you feel able to, combine chest compressions with breathing into their mouth or nose.

However, giving chest compressions is the most important thing to do because their blood already has some oxygen in it and the compressions will keep that blood pumping around their body, taking oxygen to their brain.

Breathing into their mouth or nose tops up the oxygen in their lungs. The combination of continuous cycles of 30 chest compressions followed by two breaths is called CPR (cardiopulmonary resuscitation).

How do I give rescue breaths?

If you feel able to give rescue breaths, you can do so after about 30 pushes on their chest.

To give rescue breaths, tilt their head back and seal your mouth over either their mouth or nose. Blow air into them with two steady breaths. If you are breathing into the mouth, pinch the nose. If you’re breathing into the nose, shut their mouth.

On a baby under a year old, seal your mouth around both their nose and mouth because their faces are small.

Will I restart the heart if I give chest compressions?

The chance of restarting the heart by chest compressions alone is very small. Usually, a heart needs an electric shock from an automated external defibrillator (AED) to restart.

Chest compressions pump a small amount of blood around the body to keep the organs alive, most importantly the brain.

Don’t give up even if you do not see any change in the person’s condition. Chest compressions significantly increase the chance of the person surviving.

What is an automated external defibrillator (AED)?

An AED is a machine that can be used to shock the heart back into normal rhythm.

When you open an AED case it will give you full instructions on what you should do.

Find out how to help someone who is unresponsive and not breathing when an AED is available.

What should I do if someone has been rescued from drowning and is unresponsive and not breathing?

Get the person safely to dry land without putting yourself in danger.

Check to see if they are breathing by tilting their head back and looking and feeling for breaths. If they are unresponsive and not breathing, push firmly downwards in the middle of their chest at a regular rate.

Ideally, you should alternate two rescue breaths with 30 chest compressions for anyone who has been rescued from drowning. This will help build up a supply of oxygen in their blood.

Email us if you have any other questions about first aid for someone who is unresponsive and not breathing.

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