National Audit Project Four NAP 4 What is

National Audit Project Four NAP 4

What is NAP 4? A national audit of major complications of airway management in the UK

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

Incidence? Number of Complications _________________________________________ Number of Airway Interventions Within a given time period

How many anaesthetics are performed per year in the UK? Not known No data = No denominator Snapshot of current practice needed

NAP 4 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

NAP 4 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

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

Local Reporters Used for NAP 3 – 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

Phase 2 –Airway Complications • • Data Collection Starts 1 st September 2008 Runs for 1 year Notify RCo. A /Tim Cook by email Online data submission

What sort of Complications? Inclusion Criteria • • Death Brain damage Emergency surgical airway ICU admission resulting from an airway management complication

Emergency Surgical Airway Includes • Emergency Cricothyroidotomy – Needle – Cannula • Emergency surgical airway – Cricothyroidotomy – Tracheostomy

ICU Admission Resulting from an Airway Management Complication 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 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

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

Airway Problems Elsewhere Meeting Inclusion Criteria • • • Intensive Care Unit – Inform NAP 4 Emergency Department – Inform NAP 4 Hospital wards - Do not inform NAP 4 Pre-hospital care - Do not inform NAP 4 If an anaesthetic is involved Anywhere in the hospital – Inform NAP 4

Notification of Events • Anyone may inform the college of events • Inform the RCo. A lead – Tim Cook tcook@rcoa. ac. uk • A username will be issued to enable online data submission via the DAS web-site • Data submission is required to be anonymous

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 tcook@rcoa. ac. uk • Send no patient details

Approval The process has been approved by • NRES National Research Ethics Service • PIAG Patient Information Advisory Group • CMO UK Chief Medical Officers

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

More Information – RCo. A Web-site

More Information - DAS Web-site

More Information RCo. A Bulletin September 2008 Anaesthesia News September 2008

More Information - Posters Appearing soon! • Anaesthesia departments • Intensive Care Units • Emergency departments

The End Thanks for your support