Introduction Inspiring Change, the 2017 NCEPOD report on NIV demonstrated that improvement in clinical and/or organisational care was required in 73.2% of patients. Many hospitals (45.4%) did not maintain a record of competency for staff delivering acute NIV care. BTS Quality Standards state that staff initiating or making changes to acute NIV treatment must be competent and a register should be maintained. At Sherwood Forest Hospitals, we maintained a log of competency for Band 6 acute NIV nurses but did not record evidence of training for rotating doctors or ward nurses.

Methods We developed a multifaceted, multi-disciplinary, integrated and sustainable education programme for all staff with responsibility for managing acute NIV. This comprised an E-learning package; a low-fidelity (lo-fi), in-situ simulation training and quarterly update sessions referencing our BTS NIV QI toolkit Acute NIV prescription; and posters featuring a newly created treatment acronym: ‘BREATHE’. Feedback from E-learning is electronically sought, and a register maintained through the package’s final assessment.

The simulation employed a ‘Resusci Annie’ manikin as patient, a side-room or treatment room on our acute NIV ward, and mock notes and drug card. Faculty comprised one facilitator and a respiratory specialist nurse. Junior doctors were trained in-hours during induction to the respiratory department. Pre- and post-simulation questionnaires, using a 5-point Likert scale, were completed and results analysed using a Wilcoxon signed-rank test.

Results 14 junior doctors undertook the lo-fi, in-situ simulation, and questionnaire responses demonstrated statistically significant (Table 1) improvements in knowledge, confidence, leadership and escalation.

32 staff, including 13 nurses and 19 junior doctors, completed the E-learning package within the first 2 months. Feedback was universally positive with all staff reporting that the knowledge gained will improve their work and the assessment consolidated their learning.

Conclusion Appropriate training and registration for all staff involved in acute NIV care is essential in line with BTS Quality Standards. The multidisciplinary in-situ simulation is reproducible and delivers similar outcomes to more formalised training in an expensive simulation centre. An E-learning programme is a sustainable method of integrating clinical documentation and assessments allowing a contemporaneous register of staff competency and training.