Introduction Non invasive ventilation (NIV) is safe and effective treatment for acute hypercapnoeic respiratory failure. National guidelines1 have been in existence since 2002 but despite widespread use of NIV, there is evidence to suggest that adherence is variable.2 A recent update provides a specific focus for NIV use in COPD patients and recommends a protocol for weaning.3 We sought to assess local adherence to British Thoracic Society (BTS) guidelines and outcomes in this group of patients before and after targeted education of staff involved in the provision of acute NIV.
Method In November 2008, 25 coded case notes were audited retrospectively using the BTS audit tool. The results were presented at the local Clinical Governance meeting followed by cyclical dedicated educational sessions comprising an overview of BTS guidelines and simulated clinical scenarios for Nursing and Medical staff involved in acute NIV services. A prospective audit was then conducted 6 months later to assess changes to NIV practice.
Results Analysis of the prospective study (n=25) compared to the retrospective study (n=25), demonstrated an improvement in all the assessed measures reflecting better adherence to the published guidelines .NIV was instituted within 60 min of admission in a higher proportion of patients (92% vs 80%) A similar trend was seen in documentation of initial NIV settings (84% vs 76%) and written management plans (88% vs 40%). A positive effect was also seen in the recording of blood gas analysis at 1–2 h (80% vs 56%) and at 4–6 h (72% vs 36%) Weaning as per the recommended protocol3 was achieved in 40% patients.
Conclusion Targeted cyclical didactic educational sessions for staff involved in the provision of acute NIV services improves adherence to National guidelines and potentially leads to improved patient outcomes. However, adhering to the recommended weaning protocols3 may be difficult to achieve in a busy district general Hospital with a significant number of admissions with acute exacerbation of COPD.
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