Wijesuriya Julian, Brand Jonathan
Darlington Memorial Hospital, County Durham, UK.
BMJ Qual Improv Rep. 2014 Feb 19;2(2). doi: 10.1136/bmjquality.u202785.w1275. eCollection 2014.
Airway management, particularly in non-theatre settings, is an area of anaesthesia and critical care associated with significant risk of morbidity & mortality, as highlighted during the 4th National Audit Project of the Royal College of Anaesthetists (NAP4). A survey of junior anaesthetists at our hospital highlighted a lack of confidence and perceived lack of safety in emergency airway management, especially in non-theatre settings. We developed and implemented a multifaceted airway package designed to improve the safety of remote site airway management. A Rapid Sequence Induction (RSI) checklist was developed; this was combined with new advanced airway equipment and drugs bags. Additionally, new carbon dioxide detector filters were procured in order to comply with NAP4 monitoring recommendations. The RSI checklists were placed in key locations throughout the hospital and the drugs and advanced airway equipment bags were centralised in the Intensive Care Unit (ICU). It was agreed with the senior nursing staff that an appropriately trained ICU nurse would attend all emergency situations with new airway resources upon request. Departmental guidelines were updated to include details of the new resources and the on-call anaesthetist's responsibilities regarding checks and maintenance. Following our intervention trainees reported higher confidence levels regarding remote site emergency airway management. Nine trusts within the Northern Region were surveyed and we found large variations in the provision of remote site airway management resources. Complications in remote site airway management due lack of available appropriate drugs, equipment or trained staff are potentially life threatening and completely avoidable. Utilising the intervention package an anaesthetist would be able to safely plan and prepare for airway management in any setting. They would subsequently have the drugs, equipment, and trained assistance required to manage any difficulties or complications. We suggest that this should be the gold standard of airway resource provision and is in line with NAP4 recommendations.
气道管理，尤其是在非手术室环境中，是麻醉和重症监护领域中与高发病率和死亡率风险相关的一个领域，正如皇家麻醉师学院第四次全国审计项目（NAP4）所强调的那样。对我院初级麻醉师的一项调查显示，他们在紧急气道管理方面缺乏信心，且认为缺乏安全性，尤其是在非手术室环境中。我们制定并实施了一个多方面的气道方案，旨在提高偏远地区气道管理的安全性。制定了快速顺序诱导（RSI）检查表；将其与新的高级气道设备和药品袋相结合。此外，为了符合NAP4的监测建议，采购了新的二氧化碳检测过滤器。RSI检查表放置在医院的关键位置，药品和高级气道设备袋集中在重症监护病房（ICU）。与高级护理人员达成一致意见，即经过适当培训的ICU护士将应要求携带新的气道资源参与所有紧急情况。部门指南进行了更新，以纳入新资源的详细信息以及值班麻醉师在检查和维护方面的职责。在我们的干预措施实施后，实习生报告称在偏远地区紧急气道管理方面的信心有所提高。对北部地区的9个信托机构进行了调查，我们发现偏远地区气道管理资源的提供存在很大差异。由于缺乏可用的合适药物、设备或训练有素的人员而导致的偏远地区气道管理并发症可能危及生命，并且完全可以避免。使用该干预方案，麻醉师将能够在任何环境中安全地规划和准备气道管理。随后，他们将拥有应对任何困难或并发症所需的药物、设备和训练有素的协助人员。我们建议这应该是气道资源提供的黄金标准，并且符合NAP4的建议。
