National Audit Project National Audit Project FourFour

NAP4NAP4

What is NAP4?

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

Number of Complications_________________________________________________________________________________

Number of Airway Interventions

Within a given time period

Incidence?

How many anaesthetics are performed per year in the UK?

Not known

No data = No denominator

Snapshot of current practice needed

NAP4 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

NAP4 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 NAP3 – 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 1st September 2008

• Runs for 1 year

• Notify RCoA /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

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

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 ElsewhereMeeting Inclusion Criteria

• Intensive Care Unit – Inform NAP4• Emergency Department – Inform NAP4• Hospital wards - Do not inform NAP4• Pre-hospital care - Do not inform NAP4• If an anaesthetic is involved

Anywhere in the hospital – Inform NAP4

Notification of Events

• Anyone may inform the college of events

• Inform the RCoA lead – Tim Cook tcook@rcoa.ac.uk

• A username will be issued to enable on-line 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

• CMOUK 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 – RCoA Web-site

More Information - DAS Web-site

More Information

RCoA Bulletin September 2008

Anaesthesia NewsSeptember 2008

More Information - Posters

Appearing soon!

•Anaesthesia departments

•Intensive Care Units

•Emergency departments

Thanks for your support

The End