MET Workshop

MET RN's are allowed to initiate IVF for a hypotensive patient?

• Yes

• Yes, but only if patient is not fluid overloaded or a renal patient

• No

MET RNs can administer adrenaline and amiodarone if they are ALS trained?

• Yes!

• Yes - if externally qualified (i.e. ARC)

• No

• Yes - with a medical order.

Answer explanation

SWSLHD policy does not support nurse initiated adrenaline or amiodarone in a cardiac arrest situation. No medication (unless a recognized Nurse Initiated Medication) can be administered without a medical order (verbal or written) in ICU or in general inpatient setting.

I am permitted to insert an LMA if I am trained to do so

• Yes - ARC supports this in their guideline

• Yes - if the Dr asks me to do it

• No

Answer explanation

Liverpool Hospital (inc. SWSLHD) does NOT support registered nurses inserting an LMA in ANY situation despite external accreditation. Please be mindful that external bodies (i.e. ARC, ACCCN) provide guidelines (not mandatory) for LHD's to follow, leaving the ultimate determination of tasks that can be performed to the LHD and DONMS to agree on. DONMS must accept a level of risk when determining what tasks RN's can perform in their facility.

If the Med Reg or ICU Reg is not present - I am permitted to lead the MET until their arrival

• Yes - ICU RN can assume seniority

• Yes - only whilst awaiting arrival of a senior doctor

• No

Chest re-opening is permitted on the ward for all patients who meet criteria?

• Yes - you must follow CALS algorithim

• Yes - if ICU deem it necessary

• No - it is against hospital guideline

You attend a MET call for rAF on the cardiology ward (3E). The patient required an Amiodarone bolus and will need a continuous infusion. What are your next steps?

• Nothing - patient can stay on 3E as it is the Cardiology ward

• If patient is normotensive - they will require T/F to CCU. If hypotensive - they may require ICU admission.

• Contact ICU NUM and organise admission to ICU. Patient can not stay on the ward.

It is 1am, you attend a MET call on the Paediatric ward. A 9 mth old has presented with sepsis and multi-organ failure. MET was for tachypnoea (70 bpm), severe respiratory distress and likely needs intubation. What is your escalation process?

• NICU and Anaesthetics. NETs for retrieval out.

• NICU, Anaesthetics and if available, ICU Consultant on call. NETs must be contacted.

• Scoop & run to Resus

It is 3am, you attend a MET call on 5E for desaturation and severe respiratory distress in a patient with a 1 week old tracheostomy. You cannot pass the suction catheter down the trache, and patient is becoming increasingly distressed. What now?

• Follow tracheostomy emergency management to determine/exclude causes + escalate to senior clinician (ICU SR, ENT) immediately

• Continue to attempt to pass the suction catheter and apply high flow oxygen

• Trache is likely obstructed / false aneurysm. Stop suctioning and call the ICU SR

It is 10am on a Saturday. You attend a MET call on 4D, and the patient requires CPAP. Nurses inform you they do not do CPAP on their ward and patient MUST go to ICU. What are your next steps?

• Contact ICU NUM for admission for NIV

• Contact 4E (respiratory ward) and facilitate transfer for NIV

• Inform nursing staff that CPAP can be established in all ward settings. Facilitate commencement of NIV, educate staff, and provide reassurance that MET will support them if needed

You attend a cardiac arrest and the team have already applied the pads and connected the AED. You need to connect the patient to the X Series, how do you do this?

• Disconnect from the AED, and connect directly to the X Series via the red port.

• Remove the pads, reapply ICU pads and connect to X Series

• Disconnect from AED and connect to X Series using the AED adaptor