|Non-invasive ventilation for acute hypercapnic respiratory failure, a quality improvement project.
|Folliard A, Leitermann M, Ridge P, Nasir N, Nic Aodha Bhuí B, Bajar E, Garvin D, Rooney CP, Mokoka MC
|Mayo University Hospital
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|The use of non-invasive ventilation (NIV) in the treatment acute respiratory failure has proven to limit the need of intubation, duration of hospital admission and mortality (Ferrer etal). We conducted a quality improvement project, and the global aim was to improve quality of care for patients presenting with AHRF associated with AECOPD. The smart aims were to ensure that every patient with AHRF receives evidenced based standardised treatment and to improve access to the respiratory specialist service.
A quality improvement NIV team was established, and 2-weekly meetings were held. Process mapping was used, and baseline data gathered to understand the complexities of our current system. Subsequently, SMART aims and driver diagrams were developed. A respiratory nurse attended the emergency department and the wards to screen for patients who were commenced on NIV for AHRF.
Process mapping results showed that 68% of the patients had prescription documented in their medical notes and in 53% there was a clear escalation plan documented. 63% had review by respiratory team with 0-24-hours of NIV initiation and 32% patients had respiratory follow up on discharge.
The results demonstrated the need to standardise the prescription process for NIV and hence the NIV prescription sticker to standardise treatment (Figure 1). This change idea will be tested using the PDSA cycle.