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The purpose of this article is to assess important recent guidelines on resuscitation, published in December 2005.

The guidelines are put into the context of other attempts to standardise CPR practice. An analysis of recent claims and complaints handled by the Medical Protection Society and problems reported to the National Patient Safety Agency, broadens the discussion.

A number of issues of concern arose – the competence of health professionals, recognising the deterioration of patients, communication of Do Not Attempt Resuscitation decisions, and equipment failings. Strengthening training, better monitoring and performance management are important in addressing these issues.

Health professionals have a good opportunity to avail themselves of the new CPR guidelines; it is in the public interest to try and achieve these standards.

The paper highlights the continuing risks in providing substandard resuscitation.

The purpose was to investigate what effect an intervention of low-dose, high-frequency cardiopulmonary resuscitation (CPR) training with feedback for one month would have on professionals' subjective self-assessment skill of CPR.

This study had a quantitative approach. In total, 38 firefighters performed CPR for two minutes on a Resusci Anne QCPR. They then self-assessed their CPR through four multiple-choice questions regarding compression rate, depth, recoil and ventilation volume. After one month of low-dose, high-frequency training with visual feedback, the firefighters once more performed CPR and self-assessed their CPR.

With one month of low-dose, high-frequency training with visual feedback, the level of self-assessment was 87% (n = 33) correct self-assessment of compression rate, 95% (n = 36) correct self-assessment of compression depth, 68% (n = 26) correct self-assessment of recoil and 87% (n = 33) correct self-assessment of ventilations volume. The result shows a reduced number of firefighters who overestimate their ability to perform CPR.

With low-dose, high-frequency CPR training with visual feedback for a month, the firefighters develop a good ability to self-assess their CPR to be performed within the guidelines. By improving their ability to self-assess their CPR quality, firefighters can self-regulate their compression and ventilation quality.

The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) program is known to improve team and clinical performance, but the relationship to psychological stress has not been clarified. The purpose of this paper is to evaluate team performance, clinical performance and psychological stress simultaneously in a simulation-based training combined with or without the TeamSTEPPS program.

This randomized, controlled, prospective pilot study was performed to reveal TeamSTEPPS impact on psychological stress. The course included an emergency care training course, the TeamSTEPPS program, and a scenario simulation. Ten medical student teams were randomly allocated two groups: a TeamSTEPPS group and a non-TeamSTEPPS group. Team performance, clinical performance and psychological stress were evaluated simultaneously in the course; i.e., questionnaire evaluation and an observational evaluation for team performance; an assessor’s evaluation and a simulator’s evaluation for clinical performance. Autonomic nervous activity, represented by salivary amylase levels and heart rate variability, were measured as psychological stress indicators.

Team performance and clinical performance were significantly better in the TeamSTEPPS group, while psychological stress did not differ between the groups.

This is the first study to examine the relationship between TeamSTEPPS and psychological stress. Although only preliminary conclusions can be drawn from this small-scale study, results suggest that the TeamSTEPPS program improved team and clinical performance without increasing psychological stress.

To illustrate the challenges involved in communicating cardiopulmonary resuscitation (CPR) and defibrillation information and providing lay person training to improve the chance of survival for persons suffering out‐of‐hospital cardiac arrest.

A sample of 78 lay persons employed by manufacturing firms in an industrial park were surveyed and asked to identify their attitudes toward and knowledge of lifesaving techniques and willingness to participate in CPR and AED training programs.

Findings suggest that most employees were interested in learning how to administer CPR and defibrillation. However, few had received training. The data also showed that training and relationship with a victim are determinants of level of comfort and willingness to engage in behaviors that would save a life.

Results are not necessarily representative of all programs or employees in industrial settings. Sample is US based, which may limit its generalizability.

Although few people have been formally trained, awareness levels and willingness to participate in these programs are high. Opportunities for training exist, even though resuscitation programs' communications and training may be falling short of the intended outcomes.

Lay persons' attitudes toward and experience with CPR and defibrillation training programs are examined and implications for training and marketing communications are discussed.

The purpose of this paper is to provide a viewpoint on decision making in do not attempt resuscitation (DNAR) orders from the perspective of a competent patient who requests cardiopulmonary resuscitation (CPR) when their clinical prognosis is poor. This issue will be examined from the position of patient autonomy and self determination.

The literature is reviewed including academic commentary, case law and statute.

The paper finds that factors such as futility and quality of life that engage in DNAR considerations should be gauged from the patient's perspective. There is a definite argument for supporting a competent patient's positive autonomous choice for CPR. This should feature clearly within the framework of clinical governance.

Presents a viewpoint designed to stimulate debate based on a contemporary perspective of patient autonomy.

End‐of‐life care is assuming a greater importance as evidenced by an increase in reported complaints. Decisions regarding CPR need to form part of the clinical governance agenda.

This paper provides an original viewpoint on the tension between a competent positive choice for CPR against opposing medical opinion, and argues for a resolution on a principled basis to protect patients from arbitrary decision making with regard to resuscitation.

The greater availability of life‐sustaining technology, such as cardiopulmonary resuscitation, and the medical, legal and moral pressures to use them, often enable the prolongation of lives of older people. The dying process can be extended regardless of quality of life. Further, there is much public debate on the increasing emphasis on individual rights and personal autonomy in the dying process. This qualitative study examined older people's perspectives on end‐of‐life decision‐making and advance care planning. A sample of 12 older people living in the community was recruited and studied in‐depth. A semi‐structured interview explored patients' conceptualisations of decision‐making in the later stages of life and the significant others they would like involved in the process. The data were analysed using ‘content analysis’. The resulting broad categories, themes and sub‐themes formed the foundation of an emerging model of older people talking about end‐of‐life care. Finally, results were discussed with regard to practice and policy development.

The operating theater (OT) is resource-intensive, costly and assuring its productivity is a high priority. This study aimed to examine a quality management model's effects on a hospital's OT productivity.

The participatory action research approach was used for the intervention. A multidisciplinary quality improvement team was formed. The team improved OT operational processes using an eight-step quality management model. OT’s key performance indicators such as surgical cases, surgical cancellation, bill deductions, successful cardiopulmonary resuscitation, patients' complaints and employees' job satisfaction were collected before the intervention and compared with those of after intervention to determine the efficacy of the quality management model.

Applying a quality management strategy increased surgical patients' number by 14.96%, reduced surgery operations cancellation by 14.6 %, and decreased bill deduction by 44.9%. Besides, successful cardiopulmonary resuscitation increased by 21.17%, patients' complaints reduced by 61.5% and, finally, staff satisfaction increased by 15.6 %. Improved OT productivity resulted in improved financial performance. As a result, the OT revenue has risen by 68.8%.

This study highlights that implementing the right quality management model properly enhances hospitals' productivity. It also offers suggestions on how to implement a quality management model successfully in a hospital setting.

The purpose of this paper is to investigate the effects of the intervention of low-dose, high-frequency cardiopulmonary resuscitation (CPR) training with feedback for firefighters for one month.

The study had a quantitative approach. Data were collected through an intervention by means of simulation. The data collection consisted of a pre- and post-assessment of 38 firefighter’s CPR performance.

There was a statistically significant improvement from pre- to post-assessment regarding participants’ compression rates. Compression depth increased statistically significantly to average 2 mm too deep in the group. Recoil decreased in the group with an average of 1 mm for the better. There was a statistically significant improvement in participants’ ventilation volume from pre- to post-assessment.

Prehospital staff such as firefighters, police, and ambulance perform CPR under less than optimal circumstances. It is therefore of the utmost importance that these professionals are trained in the best possible way. The result of this study shows that low-dose, high-frequency CPR training with an average of six training sessions per month improves ventilation volume, compression depth, rate, and recoil. This study concludes that objective feedback during training enhances the firefighters’ CPR skills which in turn also could be applied to police and ambulance CPR training.

The purpose of this paper is to investigate the impact of a “Do Not Attempt Resuscitation” (DNAR) order on subsequent decision making relating to the clinical care of the patient.

The approach taken was a questionnaire based on a hypothetical clinical case, completed by medical and nursing staff of all grades in general medical, surgical, and orthopaedic wards.

There is a reduction in the urgency attached to reviewing a deteriorating patient following institution of a DNAR order. Many doctors and nurses will not perform a range of interventions in the patient with a DNAR order in place. Confusion exists regarding whether an apnoeic, peri‐arrest patient should be ventilated when a DNAR order is in place.

This was a single‐centre study, looking at a hypothetical situation. Further studies at more centres, and investigating different designs of DNAR form, would clarify the best format for these to take.

A DNAR statement may often be interpreted as limiting other forms of care. This is more likely amongst more junior doctors and nursing staff, who are frequently the first line of assessment of these patients. More explicit DNAR forms may be advisable to confirm what treatments are to be continued.

This paper demonstrates that DNAR decisions are taken as a surrogate marker for limiting other forms of care, and that this extends to medical and nursing staff at all grades.

The purpose of this paper is to report the findings of the Confidential Inquiry into premature deaths of people with intellectual disabilities (CIPOLD) in relation to the Mental Capacity Act (England and Wales) (MCA) 2005.

CIPOLD reviewed the deaths of all known people with intellectual disabilities (ID) aged four years and over who had lived in the study area and died between 2010 and 2012.

The deaths of 234 people with ID aged 16 years and over were reviewed. There were two key issues regarding how the MCA was related to premature deaths of people with ID. The first was of the lack of adherence to aspects of the Act, particularly regarding assessments of capacity and best interests decision-making processes. The second was a lack of understanding of specific aspects of the Act itself, particularly the definition of “serious medical treatment” and in relation to Do Not Attempt Cardiopulmonary Resuscitation guidelines.

CIPOLD did not set out to specifically evaluate adherence to the MCA. It may be that there were other aspects relating to the MCA that were of note, but were not directly related to the deaths of individuals.

Addressing the findings of the Confidential Inquiry in relation to the understanding of, and adherence to, the MCA requires action at national, local and individual levels. Safeguarding is everyone's responsibility, and in challenging decision-making processes that are not aligned with the MCA, the authors are just as effectively protecting people with ID as are when the authors report wilful neglect or abuse.

CIPOLD undertook a retrospective, detailed investigation into the sequence of events leading to the deaths of people with ID. To the authors’ knowledge, this is the first time that such research has associated a lack of adherence to the MCA to premature deaths within a safeguarding framework.