The standard positions for electrode placement are the right (sternal) electrode to the right of the upper sternum below the clavicle, and the left (apical) electrode in the midaxillary line (Figure 12.67). The electrodes should be placed clear of any breast tissue.

Other acceptable electrode positions are:

Ensure good contact between the self‐adhesive electrodes and the patient's skin. Ensure the skin is dry and consider shaving a very hairy chest; however, it should not delay placement of the electrodes and defibrillation. This also applies to the removal of jewellery and transdermal medication patches.

High‐flow oxygen in the presence of a spark or naked flame could present a danger to the patient and rescuers. It is therefore essential to ensure that oxygen tubing and equipment are moved away from the chest when defibrillation is performed. Using adhesive electrodes as opposed to defibrillation paddles may also minimize the danger (RCUK [232]).

A metallic, wet or other conductive surface does not usually compromise patient safety when defibrillation is performed. However, the nurse must ensure the self‐adhesive electrodes are applied correctly and are in direct contact with the patient's skin. If the patient is wet, the chest should be dried so that the self‐adhesive electrodes will stick securely (RCUK [232]).

Direct contact with the patient or bed must be avoided when a shock is delivered. This guarantees there is no direct pathway for electricity to take and so prevents the user and other rescuers from experiencing a shock (RCUK [232]). The person in charge of the defibrillator during cardiac arrest must order everyone to ‘stand clear’ while the shock is delivered.

All hospital wards and departments should have a standardized cardiac arrest trolley. Resuscitation equipment, including the AED or defibrillator, should be checked on a daily basis (RCUK [232]). A record of this check should be maintained.

Decisions relating to CPR ideally should have been documented prior to a cardiac arrest. Every hospital should have a DNaCPR policy based on national guidelines (RCUK [232]).

The patient should be handed over to the cardiac arrest team to provide ongoing advanced life support. If the patient has a return of spontaneous circulation, the cardiac arrest team will consider moving them to an appropriate intensive care or high‐dependency environment once they have been stabilized. The person leading the cardiac arrest should continue to do so after the return of spontaneous circulation, or if resuscitation has been unsuccessful. They should determine who is best to facilitate the transfer, who should update the patient's next of kin, and any other issues that need to be addressed. The pastoral needs of all those professionals involved in the arrest should not be forgotten (RCUK [232]) and a debrief session is advised, regardless of whether the resuscitation was successful or not.

The Nursing and Midwifery Council ([198]) is clear that nurses should only share information with the next of kin (NOK) when consent has been given to do so. Nurses must also uphold the Mental Capacity (Amended) Act ([157]) and make sure that the rights and best interests of those who lack capacity are at the centre of the decision‐making process (NMC [198]). In the event of a cardiac arrest, when the patient will lack capacity, nurses must immediately notify the NOK. If the NOK is not present, a phone call can be made. Best practice dictates to always try to speak to the NOK directly, without releasing information to whoever answers the phone if at all possible (DH [61]). High‐quality communication is one of the most important aspects for families (Lautrette et al. [129]); therefore, while informing the patient's NOK of a cardiac arrest is a difficult task, it must be handled sensitively and with empathy. Information given should be relevant and communicated in a way that can be understood (NMC [198]).

In recent years, many hospital trusts have adopted policies that allow for family or the NOK to be present during resuscitation. The psychological benefits for the family or the NOK include enhancing acceptance and closure, and a reduction in the incidence of post‐traumatic distress syndrome (Goldberger et al. [92]). Importantly, the above benefits stand even if the patient outcome is death (Jabre et al. [118]). However, despite the well‐documented evidence and an increase in trust policies, barriers still exist. Reasons include healthcare professionals’ perception that families might interrupt care, a lack of space to accommodate family members in the room, and a perceived increased risk of litigation (Fernandez et al. [79]).

Good record keeping is an integral part of nursing practice and is essential in the provision of safe and effective care (Griffith [96], NMC [198]). Both nursing and medical staff should document the events leading up to the incident, details of the cardiac arrest, any decisions made and the patient outcome.

Hospitals should collect data regarding cardiac arrest for the National Cardiac Arrest Audit (NCAA), ideally using a nationally recognized template such as the Utstein template (RCUK [232]). Accurate recording of the time BLS commenced and the timings of each intervention, including any drugs (and dose) administered during cardiac arrest, is essential. The appointment of a scribe during the cardiac arrest is therefore recommended (RCUK [232]).

Education of patients and relevant others should be geared towards the promotion of healthy living and the prevention of cardiac disease. This includes eating a healthy, balanced diet low in sugar and saturated fat, as well as exercise, smoking cessation, and regular checkups to treat or control any underlying conditions such as hypertension and diabetes.