The 4th National Audit Project (NAP4) of the Royal College of Anaesthetists, published in 2011 identified that at least one quarter of all major airway events occurred in the intensive care unit. Further analysis highlighted areas where clinical practice could be improved, including, “poor identification of at risk groups, poor or incomplete planning, inadequate provision of skilled staff and equipment to manage these events successfully”.1
We developed a two stage educational and simulation training programme with a view to improving patient safety by addressing issues highlighted by NAP4.
Stage 1: Regular teaching was delivered to groups of nursing and medical staff on the intensive care unit. A structured approach to difficult airway management was taught.2 Key learning needs were identified and teaching was directed at helping understand the factors that make airway management difficult on Intensive Care. The intention of the teaching session was more than just education around equipment and techniques, but also served to empower the junior team members by focusing on human factors associated with critical incident management and identifying the importance of teamwork and communication.
Stage 2: Teaching sessions were reinforced by exposure to real time difficult airway simulation within the medical simulation centre at Bradford Royal Infirmary. Airway management was undertaken by junior anaesthetists from Intensive Care, supported by nurses of varying grade and experience. Scenarios were videoed, enabling structured feedback and self-critique. Formal feedback was obtained to determine the success of the programme, and identify further learning needs.
Outcomes Delivery of this programme was well received and successful in enhancing knowledge and skills around difficult airway management on Intensive Care. The global sense of achievement is one of enhanced patient safety, resulting from a better understanding of difficult airway management, and greater confidence using the equipment available within the intensive care environment.
The Fourth National Audit Project of the Royal College of Anaesthetists, March 2011
Difficult Airway Society Guidelines Flow-chart 2004
- Category: Course or curriculum evaluation/innovation/integration
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