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Abstract
Background Non-invasive ventilation (NIV) has become the standard of care for management of acute type 2 respiratory failure. There is evidence that junior doctors receive inadequate training and confidence in the use of NIV is low. National audits have shown consistent shortcomings in NIV management.
Aims To assess initiation of acute NIV in a District General Hospital setting, to provide prompt structured feedback to doctors initiating NIV and to assess whether feedback leads to improvement.
Methods A total of 72 acute NIV initiations were prospectively assessed between January and June 2014. Data from patient records was collected using a structured pro-forma to assess nine parameters (described below). A feedback email with total score out of nine along with brief written feedback was sent to all doctors initiating NIV.
Results Performance was reported for each of the nine criteria; documented indication for NIV (94%); documented NIV start time (90%); BTS recommended NIV pressures achieved (61%); ABG immediately prior to therapy (93%); ABG performed at 1–2 h (75%) and at 4–6 h (79%); documented ceiling of treatment (70%) and discussion with patient/relatives (67%); improvement in pH at 6 h (58%). Use of correct pressures led to an improvement in pH in 68% compared to 43% when inadequate pressures were used (p < 0.05). pH at 6 h improved in 81% when all initial 8 parameters were met compared to 0% with a score of 4 or less (p < 0.01). There was a trend towards increased survival with higher scores.
Scores steadily improved over the first 3 months however fell at the beginning of April, coinciding with the rotation of junior doctors, rising again towards the end of the study period.
Conclusion Better adherence with BTS guidelines led to improvements in patient outcomes. Structured feedback led to improvement in NIV initiation scores.
Rolling average of last 6 scores – total out of 9 parameters assessed