National Audit Project Four
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Transcript of National Audit Project Four
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National Audit Project National Audit Project FourFour
NAP4NAP4
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What is NAP4?
A national audit of major complications of airway management
in the UK
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Why?
To determine the incidence of serious complications of airway management in UK anaesthetic practice
To look for themes and to learn from adverse events
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Number of Complications_________________________________________________________________________________
Number of Airway Interventions
Within a given time period
Incidence?
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How many anaesthetics are performed per year in the UK?
Not known
No data = No denominator
Snapshot of current practice needed
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NAP4 needs two phases
Phase 1• A snapshot of practice• Over a 2 week period• During September 2008• Provides denominator
Phase 2• Study of complications• Over one year• 01/09/2008 - 31/08/2009• Provides numerator
Number of complications_________________________________________________________________________________
Number of Airway Interventions
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NAP4 needs two phases
Phase 1• A snapshot of practice• Over a 2 week period• During September 2008• Provides denominator
Phase 2• Study of complications• Over one year• 01/09/2008 - 31/08/2009• Provides numerator
Number of complications_________________________________________________________________________________
Number of Airway Interventions
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Phase 1- The Snapshot
Data Collection
• All anaesthetics in a hospital
• Over the same 2 week period
• Submit data on clinical activity• Number of general or regional anaesthetics• Airway management of cases under GA
• All hospitals in the UK
• Co-ordinated by the Local Reporter
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Local Reporters
Used for NAP3 – Central neuraxial blockade
• Have an essential central role
• Disseminate information
• Collect data - snapshot
• Support local anaesthetists
• Aid reporting of adverse airway events in phase 2
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Phase 2 –Airway Complications
Data Collection
• Starts 1st September 2008
• Runs for 1 year
• Notify RCoA /Tim Cook by email
• Online data submission
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What sort of Complications?
Inclusion Criteria
• Death
• Brain damage
• Emergency surgical airway
• ICU admission resulting from an airway management complication
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Emergency Surgical Airway
Includes
• Emergency Cricothyroidotomy– Needle– Cannula
• Emergency surgical airway – Cricothyroidotomy– Tracheostomy
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Example cases for inclusion• Post extubation stridor requiring re-intubation
and ICU admission• Elective ventilation following hypoxic cardiac
arrest due to an airway problem during anaesthesia
• ICU admission following aspiration of gastric contents during an operation
ICU Admission Resulting from an Airway Management Complication
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ICU Admission Resulting from an Airway Management Complication
Example of cases for exclusion
• ICU Admission for unrelated reasons• ICU Admission because HDU was full• HDU admission following aspiration of gastric
contents with complete resolution
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When does it start?
• Snapshot of current practice– 2 week period September/October 2008
• One year data collection process– 01/09/2008 to 30/08/2009
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Airway Problems ElsewhereMeeting Inclusion Criteria
• Intensive Care Unit – Inform NAP4• Emergency Department – Inform NAP4• Hospital wards - Do not inform NAP4• Pre-hospital care - Do not inform NAP4• If an anaesthetic is involved
Anywhere in the hospital – Inform NAP4
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Notification of Events
• Anyone may inform the college of events
• Inform the RCoA lead – Tim Cook [email protected]
• A username will be issued to enable on-line data submission via the DAS web-site
• Data submission is required to be anonymous
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All you need to remember is..
• If you know of an airway problem resulting in:– Death – Brain damage – Emergency surgical airway– ICU admission resulting from an airway
management complication
• Inform Tim Cook [email protected] • Send no patient details
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Approval
The process has been approved by
• NRES National Research Ethics Service
• PIAG Patient Information Advisory Group
• CMOUK Chief Medical Officers
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Supported by• Royal College of Anaesthetists• Difficult Airway Society• National Patient Safety Agency• Association of Anaesthetists of Great Britain and Ireland, • Association for Peri-Operative Practice• Association of Paediatric Anaesthetists • College of Emergency Medicine • College of Operating Department Practitioners• Intensive Care Society• Intensive Care National Audit and Research Centre• Obstetric Anaesthetists Association • Paediatric Intensive Care Society• Paediatric Intensive Care network • All Chief Medical Officers • Medical Defence organisations
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More Information – RCoA Web-site
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More Information - DAS Web-site
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More Information
RCoA Bulletin September 2008
Anaesthesia NewsSeptember 2008
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More Information - Posters
Appearing soon!
•Anaesthesia departments
•Intensive Care Units
•Emergency departments
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Thanks for your support
The End