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    CPD-Difficult Airway Equipment Clinical Audit Guide

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    Maaz S
    This document provides guidelines for conducting an audit of difficult airway equipment. It outlines the background, aim, objectives, best practices, standards, method, and references to consider. The goal is to identify any deficiencies in the existence, location, labeling, and contents of difficult airway trolleys, and to improve access to difficult airway equipment in order to reduce morbidity and mortality during airway emergencies. The audit method involves assessing whether each trolley contains the required equipment and documentation of regular maintenance, according to best practice standards.

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    CPD-Difficult Airway Equipment Clinical Audit Guide

    Uploaded by

    Maaz S
    109 views3 pages
    This document provides guidelines for conducting an audit of difficult airway equipment. It outlines the background, aim, objectives, best practices, standards, method, and references to consider. The goal is to identify any deficiencies in the existence, location, labeling, and contents of difficult airway trolleys, and to improve access to difficult airway equipment in order to reduce morbidity and mortality during airway emergencies. The audit method involves assessing whether each trolley contains the required equipment and documentation of regular maintenance, according to best practice standards.

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    Airway guide

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    This document provides guidelines for conducting an audit of difficult airway equipment. It outlines the background, aim, objectives, best practices, standards, method, and references to consider. The goal is to identify any deficiencies in the existence, location, labeling, and contents of difficult airway trolleys, and to improve access to difficult airway equipment in order to reduce morbidity and mortality during airway emergencies. The audit method involves assessing whether each trolley contains the required equipment and documentation of regular maintenance, according to best practice standards.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    109 views3 pages

    CPD-Difficult Airway Equipment Clinical Audit Guide

    Uploaded by

    Maaz S
    This document provides guidelines for conducting an audit of difficult airway equipment. It outlines the background, aim, objectives, best practices, standards, method, and references to consider. The goal is to identify any deficiencies in the existence, location, labeling, and contents of difficult airway trolleys, and to improve access to difficult airway equipment in order to reduce morbidity and mortality during airway emergencies. The audit method involves assessing whether each trolley contains the required equipment and documentation of regular maintenance, according to best practice standards.

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    of 3

    CLINICAL AUDIT GUIDE

    Adequacy of difficult airway requirement audit


    Please check with your local ethics service or governing body as to the process requirements for conducting an audit of your own practice.

    Difficult airway (DA) scenarios and airway complications are a leading cause
    Background
    of anaesthetic morbidity and mortality.1,2,3
    The UK’s NAP4 results and the review from the American Society of
    Anesthesiologists closed claims database analysis suggest many of these
    cases are preventable.1
    Expertise in airway management, including that of a difficult airway, is an
    essential skill for anaesthetists. In the event of an unanticipated difficult
    airway or airway complication, the effective management of a difficult airway
    depends on essential equipment being rapidly available.
    Airway complications can occur during all phases of the anaesthetic
    process. NAP4 demonstrated that while induction was the phase when most
    events occur, a significant minority occurred during emergence and in (or
    during transfer to) the recovery area. This illustrates the need for a DA
    trolley to be easily accessible in all areas of a complex that provides
    anaesthesia and recovery/ post anaesthesia care.
    Several algorithms and flowcharts have been formulated by various bodies
    such as the American Society of Anesthesiologists (ASA), the UK’s Difficult
    Airway Society (DAS) and more recently in Australia, the “Vortex Approach”,
    to effectively manage the difficult airway as well as the “can’t intubate and
    cant ventilate” situation.4,5,6
    The Australian Incident Monitoring Study (AIMS) identified equipment
    deficiencies, which were mainly due to failure to check, as responsible for a
    third of the contributing factors identified in the difficult intubation reports.7
    An audit in New Zealand identified inconsistencies and deficiencies in the
    airway equipment available in a major metropolitan area and the UK, there
    is evidence that the location and contents of DA equipment is poor.8
    In 2012 ANZCA developed evidence based guidelines on equipment to
    manage a difficult airway during anaesthesia (PS56) which specifies
    essential equipment for management of a difficult airway as well as its
    storage and location.9
    Essential equipment should include simple airway adjuncts, intubation
    equipment, supraglottic ventilation devices and an emergency
    cricothyrotomy oxygenation system.9,10,11

    Aim and objectives To identify areas of potential deficiency in the existence of, locations for,
    labelling and/ or contents of Difficult Airway (DA) Trolleys in various
    departments where general anaesthesia occurs.
    To improve, where possible, the contents of and access to difficult airway
    equipment.
    Improvement in the speed of access to and ease of locating equipment
    within a DA trolley in an emergency could reduce morbidity and mortality
    relating to difficult airway management.

    Clinical audit guide Difficult airway equipment | 1 of 3


    Research evidence/ ANZCA background paper on PS56 recommends that a carefully selected
    best practice range of equipment is essential for successful and safe patient outcomes.
    This equipment needs to be checked, in good working order and readily
    available to hand. There is no magical device or technique that will be
    suitable for all airway problems, so therefore a range of equipment is
    required.12
    The DAS website has recommended equipment lists to
    go with its algorithms.5
    The UK’s Royal College of Anaesthetists ‘Guidelines for the provision of
    anaesthetic services’ refer to a need for specialist airway equipment and
    state ‘within each theatre suite, there must be at least one portable storage
    unit with specialised equipment for managing the difficult airway.’13
    The NAP4 Executive Summary recommended that national standardisation
    of Advanced Airway trolleys should be given consideration and that each
    hospital should ensure a minimum level of airway equipment for all sites
    where airway management may be performed.1

    Suggested indicators  Existence of a named consultant responsible for the DA set.


     Immediate availability of a DA set in all areas where anaesthesia is
    administered, which includes a list of contents and an algorithm
    flowchart of advanced airway management.
     Each cart is laid out in a simple, structured manner with labelled
    drawers and including airway adjuncts, intubation kit, supraglottic
    ventilation devices and emergency cricothyrotomy kit (including
    oxygen delivery).
     There is documentation of regular maintenance and stocking of each
    DA set.

    Standards and  A named consultant should be responsible for the DA set.


    criteria for best  100% DA trolley should have a simple layout with labelled drawers, a
    practice list of contents and an algorithm flowchart of advanced airway
    management.
     100% DA trolleys should include all equipment included on the trolley
    contents list.
     100% DA trolleys should include evidence of regular maintenance.

    Method Each hospital or practice determines the suitable contents of the DA trolley
    and creates a list of contents.
    Each trolley should be assessed as to whether it contains the equipment as
    detailed on the contents list, that essential equipment is on the trolley and
    that there is evidence of regular maintenance. A consultant should be
    responsible for ensuring DA trolleys are suitably stocked and equipment
    replaced when used.

    1. NAP4: Major complications of airway management in the UK. Report


    References
    and findings of the 4th National Audit Project of The Royal College of
    Anaesthetists. RCoA, London March 2011
    (http://www.rcoa.ac.uk/nap4).
    2. Caplan RA, Posner KL, Ward RJ, Cheney FW. Adverse respiratory
    events in anesthesia: a closed claims analysis. Anesthesiology
    1990;72(5):828-33.
    3. Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney
    FW. Management of the difficult airway: a closed claims analysis.
    Anesthesiology 2005;103(1):33-9.

    Clinical audit guide Difficult airway equipment | 2 of 3


    4. American Society of Anesthesiologists Task Force on Management
    of the Difficult Airway. Practice guidelines for management of the
    difficult airway: an updated report by the American Society of
    Anesthesiologists Task Force on Management of the Difficult Airway.
    Anesthesiology 2003;98(5):1269-77.
    5. Henderson JJ et al. Difficult Airway Society guidelines for the
    management of the unanticipated difficult intubation. Anaesthesia
    2004;59:675–684.
    6. The Vortex Approach: Management of the Unanticipated Difficult
    Airway, by Nicholas Chrimes and Peter Fritz, 2013 , Ebook
    7. Williamson JA, Webb RK, Szekely S, Gillies ER, Dreosti AV. The
    Australian Incident Monitoring Study. Difficult intubation: an analysis
    of 2000 incident reports. Anaesth Intensive Care 1993;21(5):602-7.
    8. Baker PA, Hounsell GL, Futter ME, Anderson BJ. Airway
    management equipment in a metropolitan region: an audit. Anaesth
    Intensive Care 2007;35(4):563-9.
    9. Australian and New Zealand College of Anaesthetists (ANZCA)
    Professional Document PS56: Guidelines on Equipment to Manage a
    Difficult Airway During Anaesthesia
    10. Cook TM, MacDougall-Davis. Complications and failure of Airway
    Management. British Journal of Anaesthesia 109 (s1):i68-i85 (2012)
    11. Heard AMB, Green RJ, Eakins P. The formulation and introduction of
    a ‘can't intubate, cant ventilate” algorithm into clinical practice.
    Anaesthesia; 2009, 64: 601-608
    12. Australian and New Zealand College of Anaesthetists (ANZCA)
    Guidelines on Equipment to Manage a Difficult Airway During
    Anaesthesia :Background Paper PS56BP
    13. Guidance on the provision of anaesthesia services for intra-operative
    care. RCoA, London 2009.

    Acknowledgement This audit guide is adapted from Macguire, B. ‘Adequacy and location of
    advanced airway equipment’ In: Royal College of Anaesthetists. Raising the
    Standard: a compendium of audit recipes, 2012; p.92-93.
    The Royal College has kindly granted ANZCA permission to use this
    material.
    Author: Dr Helen Ward, FANZCA. July 2015.

    Associated documents:

    Adequacy of Difficult Airway Equipment Data Collection Form

    Adequacy of Difficult Airway Equipment Results Summary & Conclusions Form

    Clinical audit guide Difficult airway equipment | 3 of 3

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