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Abstract
Introduction and objectives Respiratory failure is a common clinical problem and a number of treatment options are available. NIV is an established treatment for hypercapenic type two respiratory failure (RF). High Flow Nasal Oxygen (HFNO) is an alternative to standard oxygen or CPAP, and its use in hypoxemic patients has been growing.
NHS adheres to evidence based guidance and protocols to improve the safety, quality and consistency of care. We developed and implemented local guidance and protocols for managing respiratory failure with HFNO and NIV in a District General Hospital.
Methods A retrospective analysis of data from inpatient type 2 respiratory failure and NIV prior and post BTS Guideline based local protocol implementation was collected. Analysis was done to assess adherence to protocol and compare quality care and outcomes with data prior to implementation. For type 1 respiratory failure a literature review was done, evidence appraised and local guidance and protocol for HFNO developed and a pilot study conducted.
Results Since introduction of NIV proforma: NIV more frequently initiated in appropriate setting. Compliance with recommended ABG monitoring improved from 85% to 100%. Documentation of escalation plans improved from 50% to 100% (Figure 1).
HFNO was successfully implemented and commenced in our Trust over 10 weeks. All patients on HFNO tolerated therapy. Prevented ITU admission in 80% of cases selected for monitored ward based care of respiratory failure.
Conclusions In the present study, we showed how to safely implement evidence based local guidance and protocol based care plans for managing type 1 and 2 respiratory failure in a DGH to improve quality of care, improve adherence to BTS guidelines, reduce in-hospital mortality and prevent ITU admission.
We believe the guideline and protocol supported the on-call teams to identify and safely manage respiratory failure. We continue to evaluate the service.
Data comparison: documentation and mortality before and after introducation of NIV proforma