Patient safety
used. It also became evident that there were a multitude of practices that had never been risk assessed.
Improvement Initiatives It is acknowledged that, until now, there has not been any solution designed and risk assessed, to secure an airway device in the theatre environment, leaving a vacuum where healthcare professionals worldwide are forced to improvise by developing their own techniques and by using off-label generic materials such as tape and ties. There are also a huge number of varying circumstances encountered involving the use of different airway products and surgical positions which further complicates matters when it comes to a standardised approach to airway device securement. The goal of this project has been to shine a light on existing practices and highlight the harm that is being caused to patients through lack of guidance and to show that better solutions and guidance are needed. It is the opinion of the short life working group that the report produced by the group provides compelling evidence that urgent review is required of existing practices and for guidelines to be established, supporting the requirement for dedicated medical devices to perform airway device securement. Despite its contributions, this study is not without limitations. First, the sample size and demographic diversity may not fully represent the broader population within the given environment, limiting the generalisability of the findings. Secondly, the study design, whether cross-sectional, longitudinal, or experimental, may introduce biases or limit casual inferences. Data collection methods, such as self-reported surveys or interviews, could lead to potential inaccuracies due to recall bias or social desirability bias. Furthermore, external factors not accounted for in the analysis, such as environmental or cultural differences, could have influenced the outcomes. Future research would address these limitations by incorporating larger and more diverse samples, refining methodology, and exploring additional variables. However, the outputs do highlight the issue that the project is championing for change. While this report2
is
sponsored by Pentland Medical, it is designed to highlight the issues required to drive safety improvement for better and safer patient outcomes. Facial harm, infections and more serious
incidents are entirely preventable, yet the absence of national guidelines has resulted in an inconsistent approach to securing an airway device within UK hospitals. A survey of healthcare
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practitioners was developed to explore whether there is a standardised approach to securing an airway device in their hospital. The intention was to use the findings to support ongoing work around safer patient care and better clinical outcomes. Some questions and responses from the
survey include: Are you aware of any incidents of poor patient care resulting from current airway securement techniques? If so, please provide details below. Of the responses received 23% of the people surveyed were aware of incidents of poor patient care resulting from their airway securement techniques.
How do you currently secure an airway?
Are you aware of the infection prevention risks when using adhesive tape to secure an airway?
l Yes = 56.5% l No = 43.5%
The results show that 56.5% of the respondents were aware of the infection risks associated with using tapes. However, they continued to use this as a method of securing the airway device even though it is an unlicenced and unhygienic way of managing the securement.
l Tapes and Ties = 57.3% used this method of securing
l Elastoplast or Similar = 20.16% used this method of securing
l Fit for Purpose Device (not specified) = 4.3% l Mixture of all or another method = 8.7% used a mixture of methods depending on procedure
l No response = 9.4%
Is there a standardised approach to securing an airway in your theatre?
Are you aware that the airway may migrate during an intervention, and this could cause harm to the patient? The survey results showed that 95.7% of the respondents were aware that the airway may migrate during the intervention and could cause serious harm to the patient but continued to use the same methods of securement. The responses show that there is a need to provide nationally recognised guidance and training by employing organisations. For agency practitioners, who make up part of the theatre team, this guidance should form part of their induction and possibly part of their requirement to work through a recruitment agency. The purpose of the focus groups was not
to determine actionable recommendations but to provide insight into how things are currently being undertaken and take these ideas, thoughts and suggestions to the short life working group. Focus group key findings:
l Yes = 72% l No = 21% l Unsure = 7%
Those surveyed, who answered ‘Yes’ to the above question, considered tapes and ties as a standardised approach to securing the airway. The comments showed that the decision
regarding the method of securing the airway was generally consultant led, however, in 90% of the cases, the ODP or Anaesthetic Nurse would be responsible for securing the airway device.
l Patients were being harmed because of the methods currently in place to secure an airway device and while some were considered minor incidents, there were mentions of more serious patient outcomes, including cardiac arrest, oesophageal tear, resulting in the death of the patient.
l Running the focus groups has strongly highlighted the difficulties around standardisation of the airway securement process.
l The consensus across the focus group discussions was that everyone in the environment had a responsibility for the patient in the anaesthetic room and that their safety was paramount.
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