Improving apnoeic oxygenation use for rapid sequence intubation in an emergency department

Abstract

BackgroundApnoeic oxygenation has been proven to be effective in the context of an emergency rapid sequence intubation (RSI). However, the use of apnoeic oxygenation for RSI carried out within our Emergency Department (ED) was only 32%. MethodsA quality improvement initiative was started to improve the use of apnoeic oxygenation. An initial assessment was carried out by surveying 173 staff. Although 139 (80%) have heard of apnoeic oxygenation, but only 78 (45%) believed that apnoeic oxygenation was of proven benefit. This translated to only 17 (10%) personnel carrying out apnoeic oxygenation 100% of the time in their practice. The following interventions were used: staff education to create awareness and change belief; staff training using demonstration and simulation sessions to show application of procedure to patient care; reminders with use of posters and by staff champion; and use of checklist and electronic records documentation to standardise procedure and tracking. The compliance was tracked and audited as part of the department's airway registry. ResultsFollowing our interventions for 3 months, the use has increased steadily to 87%. This compliance was sustained at re-audit 10 months later. ConclusionsThrough simple interventions carried out in a sustained manner, the use of apnoeic oxygenation was successfully incorporated to the standard operating procedure during RSI performed, thereby improving outcomes during RSI for our critically ill patients.