Patient safety
articulated stylets that enhance the safety and effectiveness of airway device placement, they do not provide detailed instruction on securing the device to the patient’s face. Emergency airway management (EAM) is commonly performed in the critical care setting. Despite clinical advances that help practitioners identify patients at risk from a difficult airway, improved airway management tools and algorithms that guide clinical decision making, again there is no direction/guidance to support practitioners when securing the device in place. In the article ‘Design and Implementation of Airway Response Teams to Improve Patient Safety, Kelly Tankard et al,4
reviews the risks and
challenges associated with emergency airway management and describes the strategies to improve patient care and outcomes. Many of the articles available to read cite ongoing education as one of the most crucial elements of managing the patient airway, for all involved with securing the airway. Many institutions have integrated crisis management training, including human factors education into their anaesthesia and airway management programmes. As with all learning, simulations help practitioners anticipate the challenges such as a difficult airway and refine their decision- making processes. Simulated learning offers a dynamic and
risk-free environment where learners can apply theoretical knowledge to practical scenarios, enhancing understanding and retention. By mimicking real-world situations, it allows individuals to develop critical skills, problem- solving abilities, and confidence without the consequences of real-life errors. This approach is particularly valuable in fields like healthcare, aviation, and engineering, where hands-on experience is essential but mistakes can be costly. Additionally, simulations can be tailored to replicate diverse challenges, fostering adaptability and decision-making in a controlled, repeatable setting. Decades ago, the introduction of pulse
oximetry and end-tidal CO2 were associated with
a reduction in respiratory-related anaesthetic death and brain damage. There is a continuing desire to make airway management safer along with the impact we are having on patient safety events. Innovations and new equipment continue to be developed to support safer anaesthetic practices. However, if healthcare professionals were to put forward the suggestions of tapes and ties to the regulatory bodies that manage new innovations, they would not pass the scrutiny and rigor and endure the processes in place to get the product to market. This speaks volumes about the archaic way of securing an airway device – but how do we encourage change and tackle the ‘this
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is the way we have always done it’ mentality? New regulatory systems and sometimes political unawareness can cause pressures on the industry due to their often-single minded need to cut headline costs. Only recently, the Association for British Healthcare Industries announced that £50k worth of registration projects have been withdrawn due to the costs associated with compliance. This will have a catastrophic impact on much needed healthcare innovation. Reuters have identified in their article in 20225 that many industry partners are no longer taking their product to market due to the high costs involved in the process. It is scandalous to think that some of these products are being designed to support patient safety and will now not be entered into the medical device arena, but we continue to use unlicensed products to secure an airway device.
Collaboration Using a multidisciplinary and collaborative approach to create initiatives helps to emphasise and support time. The project has highlighted the importance of a team approach when endeavouring to develop a standardised approach to different elements of the critical care environment. During our focus groups, we asked the question: ‘How would you define a standardised approach – can you share an example of processes that should be standardised?’ Some examples of the things shared that
practitioners had been able to standardise were: l Securing the eye with Eye Guard, which is safer than tape for securing the eye.
l Streamlining the storeroom to make it easy to find things and cut down on time when a product is required. The outcome was that smaller areas were required for storing stock. It has proven to be cost effective as
not overstocking.
l The WHO checklist. Identified checklist champions to implement this initiative. Basically, used a team who would kick up the least fuss.
l Giving sets have been standardised; now have one set for blood fluids.
l Standardised the difficult airway trolley and have guidelines available on the trolleys to support use.
l Standardisation of the anaesthetic trolleys and the cannulation trolleys.
l Trolley for tubes specific to the speciality. l Tracheostomy trolleys but there needs to be flexibility for outside cases.
l Standardising the drug cupboards to make it easier for visiting ODPs and has made it more cost effective. Have removed 100 drugs from cupboards, now only have the set drugs in the cupboards, they used to be jam packed. We are seeing some creep back into old habits. Will need continually monitoring to ensure only the drugs allowed on the list are kept in the cupboards.
l Stop before you block – it has become a standard way of working.
l Introduction of universal drug trays – there is a list on the wall and the trays are replenished from the drug cupboard.
l Changed the way we marked patient to avoid wrong side blocks. The ideas originated from a porter who observed practice and made a suggestion. We should all be involved in suggestions.
There was discussion about how standardisation of certain practices made things much easier. However, it was thought that all approaches for standardisation should be backed up by rationale and be evidence based. Those involved in the discussions felt that training of new members of the team would be much easier if
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