Patient safety
procedures that are normally routine become much more challenging. In Ethan’s case, the situation was life threatening and this was made more difficult because of his complex disease and the affect this had on the anatomy of his airway. We saw that this situation is incredibly distressing for patients, their families and staff involved in their care. “Talking to and working with healthcare
professionals, and national bodies that can influence change, we have developed recommendations and observations aimed at ensuring a robust system is in place to support effective communication and collaboration when it comes to more advanced airway management in people with an anticipated difficult airway. Specifically, there is a requirement for a robust process for documenting and sharing an individualised airway management plan for people with a complex disease to all healthcare professionals and services involved in their care. This will help to mitigate risks to any patient, but primarily for those who are most vulnerable when experiencing an airway emergency.”
Findings in full l There is no nationally recognised system for sharing clinical information about people with a known difficult airway between primary, secondary, and tertiary care.
l There is no standard process for documenting and sharing an individualised airway management plan for people with a complex disease to all healthcare professionals and services involved in their care.
l Multidisciplinary team meetings to discuss the care of people with a complex disease and who have a known difficult airway are not happening consistently between primary, secondary, and tertiary care.
l Existing guidance for healthcare professionals, on how to care for people who have a complex disease and may have a difficult airway, is not always co-ordinated and consistent.
l There is currently no national standard for treating people with a known potentially ‘life threatening’ difficult airway who require advanced airway management.
l The requirement for additional skills, for example a head and neck specialist or ear, nose, and throat (ENT) specialist, in emergency situations where a patient requires advanced airway management is challenging as 24-hour on-site ENT provision is not available in every hospital.
l Training and competency assessment in videolaryngoscopy is not standardised and there is variability in how and when videolaryngoscopy is used.
l Training and competency assessment for anaesthetists on airway rescue techniques
such as emergency front of neck airway (eFONA) is variable.
l The design of equipment to support advanced airway management does not consistently include robust user testing at a national level to help identify and understand risks.
Recommendations The report also outlines key recommendations: l NHS England should identify and implement a system for sharing clinical information about people with a known difficult airway. This is to improve access to this information for healthcare professionals and reduce the risk of a person’s known difficult airway not being recognised.
l The Royal College of Anaesthetists should work with the Difficult Airway Society and other key stakeholders to produce a framework on the management of a potentially ‘life threatening’ difficult airway for people with a known difficult airway who require advanced airway management. This work should consider the adoption of a common language which defines and explains principles for treating people with a known potentially ‘life threatening’ difficult airway who require advanced airway management. This could optimise the chances of survival for people who experience a life-threatening airway emergency.
l The Royal College of Anaesthetists should make changes to its Guidelines for the Provision of Anaesthetic Services (GPAS) requirements for all anaesthetists, to include guidance on: requirements for anaesthetists to have access to videolaryngoscopes in all locations where
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