Development of a new nurse-led non-invasive ventilation (NIV) initiation pathway for children and young people (CYP)

Abstract

<b>Background:</b> Initiating NIV in CYP is challenging. Traditionally at our centre, acute beds were used for this with mean 4 nights’ stay. In 2018, a new nurse-led NIV pathway was developed to minimise admission and improve patient experience. This involved preparation in outpatient setting by respiratory nurse specialist (RSN) and once patient was ready, a 1-2 nights’ stay on sleep unit was planned. Further 4-week remote monitoring/support was offered and ventilator settings titrated by RSN. <b>Aims:</b> To assess effectiveness of new nurse-led NIV initiation pathway. <b>Methods:</b> Retrospective review of CYP who initiated NIV via the new pathway between 2018-22 at a specialist paediatric sleep centre was done. <b>Results:</b> 50 CYP (aged 9months-18 years, 35M:15F) were referred for NIV via new pathway (45 already completed/ 5 underway). Of the 45, 41 (91.1%) CYP successfully established NIV; 9 BIPAP/32 CPAP. Only 4 failed to tolerate NIV despite all strategies. A mean of 5.2 (range 1-28) outpatient appointments per patient were required with 2 weeks to 12 months duration between referral and starting NIV. 26 CYP with learning difficulties (LD) required play and school input and took the longest. 39 patients established with 1-2 nights’ stay on sleep unit (saving an estimated 156 acute bed days). Family feedback was very positive and they felt supported during the process. <b>Conclusion:</b> The new nurse-led NIV initiation pathway is an effective and improved way for CYP to establish NIV with high success rate and huge impact on saving acute bed usage. It improves patient experience and offers ability to support challenging groups of CYP such as those with LD to successfully establish on NIV.