Patient safety
Patient safety improvement initiatives
Dawn Stott provides an insight into some key improvement initiatives around the safe management of airway devices and shares the findings from NHS Trust freedom of information requests, surveys and focus groups. The research underscores the importance of continuous learning, and a culture of transparency and collaboration across disciplines to sustain improvements in patient safety.
Securing an airway device is a critical component of patient safety, particularly in situations where airway management is essential to life support, such as during surgery, emergency care or critical illness. The airway device, typically an endotracheal tube (ETT) or laryngeal mask airway (LMA) ensures that a patient’s airway remains open for adequate oxygenation and ventilation. A wide range of airway devices and techniques have been created to enhance the safety of airway management. However, as Gaszyński et al point out, airway management remains a challenge.1 Ensuring proper securing of the device
is paramount as any displacement or dislodgement can lead to life-threatening complications like hypoxia, aspiration or airway obstruction. Additionally, off-label materials commonly used to secure the airway, such as tape and ties, can cause facial damage ranging from minor redness to severe tissue damage. Tape especially is an infection risk, but perhaps more pertinently; any off-label methods are not fit for purpose. Although they are imbedded in healthcare culture and have been used the world over for generations, tape and ties were never designed to perform airway securement.
Background In October 2023, Pentland Medical and Dawn Stott Associates formed a working relationship to raise awareness of the hazards and patient safety risks associated with securing a patient airway device in the theatre and critical care environments. Following an inaugural round table discussion meeting it was agreed that a ‘cross sector’ Short Life Working Group (SLWG) would be formed to facilitate a consultation on the way an airway device is currently secured when a patient is undergoing a surgical intervention. The group’s goals were acknowledged as identifying systemic barriers to the standardisation of airway management
and to develop guidance to support a more robust and consistent way of securing the airway device. Initially, the group’s mission has been to
review current policy, guidance and legislation; to help interpret and apply them to daily anaesthetic practice; to support healthcare facilities and personnel with materials and resources on airway device securement and management; to help ensure compliance with policy to establish an environment where standardisation of approach is accepted and guidance is available to support healthcare professionals ensure the patient, for whom they are advocating, is safe. The group have also reviewed the broader issues around patient safety, cultural challenges around change management and particularly that securing an airway device with tapes is not the best way to secure such a vital piece of equipment. The methodology the group agreed on
was collecting relevant data and information to support any decision making. This was initially through running several focus groups, undertaking a survey of clinical professionals working in the theatre or critical care environment and freedom of information (FOI) requests to NHS Foundation Trusts. When research first started on the area of
airway device securement, it was astonishing to find that no guidance existed from any recognised bodies in the UK and only a brief mention of the subject could be found. The airway is one of the most vital pieces of equipment in any general anaesthetic, and the Difficult Airway Society (DAS) are generally regarded as the leading authority on anything airway related, not just in the UK but are also internationally recognised. However, the DAS guidance states nothing
beyond the fact that healthcare professionals should secure the airway device, with no advice on best techniques or materials that should be
May 2025 I
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