NIV –a safer way of delivering the goods : North Middlesex Hospital Emergency Department

Authors Emergency medicine consultants Ehsan Hassan and Talia Barry

The problem

Emergency departments deliver NIV in the form of CPAP or BiPAP frequently. Staff delivering it may not be respiratory-trained nurses or doctors, things can go wrong. We had a ‘never event’ where a patient was transferred on NIV with a closed 02 valve. Our department needed a ‘how to do’ guide on setting up NIV to reduce error and decrease stress for clinicians at a critical, timedependent moment and we needed to improve our documentation.

Method

A Plan Do Study Act cycle to introduce CPAP and BiPAP prescription forms in the resus area, an action group involving respiratory medicine, ITU and ED nurses and doctors, delivery of training in morning handover

Results and reflection

Improved documentation from 55% to 80% in first cycle, reflecting that the booklet was too long so was reduced from 4 to 1 page, a need for repeat reminders to embed process

References: https://www.england.nhs.uk/publication/never- events/ : https://www.britthoracic.org.uk/document-library/clinical-information/acute-hypercapnic-respiratory-failure/btsguidelines-forventilatory-management-of-ahrf/