In December 2022, 24 colleagues from six regional acute hospital trusts and the West of England AHSN came together to launch a new collaborative project focused on improving patient outcomes from non-invasive ventilation (NIV).
Acute NIV is an evidence based, clinically effective and lifesaving treatment used to manage patients presenting with specific conditions in Type II (hypercapnic) respiratory failure. In 2019, a British Thoracic Society (BTS) audit on adult NIV care reported the inpatient mortality rate was 26%. This was an improvement on previous audits in 2010 and 2013, however mortality rates remained higher than in other countries.
This unique project aims to reduce mortality rates to 10% or lower for patients who require acute NIV for Type II respiratory failure. This will be achieved through a collaborative approach which implements a regional standardised care bundle.
The five bundle elements are:
- Appropriate case selection – NIV is only recommended in acute Type 2 Respiratory Failure where it is proven to be effective.
- Treatment Escalation Plan in place – ReSPECT form to be completed with specific reference to suitability for invasive ventilation or NIV as ceiling of treatment.
- NIV to be started within 60 minutes of decision to treat.
- Inspiratory pressure of 20cmH₂O to be achieved within 60 minutes.
- Arterial or capillary blood gas to be repeated within two hours of starting NIV.
Read about the drivers informing our NIV project in a blog from Dr Rebecca Mason.
Dr Rebecca Mason, project Clinical Lead and Respiratory Consultant at the Royal United Hospital, Bath said:
“This new pan-regional project seeks to improve NIV outcomes for patients through the implementation of a regional standardised care bundle, based on the BTS quality standards. In addition, we aim to improve staff knowledge, and competence in use of NIV, along with patient experience through enhanced communication and development of teaching materials”.
Dr Mark Juniper, Medical Director at the West of England AHSN and Respiratory Consultant, Great Western Hospitals, Swindon said:
“It was great to host this event. The energy in the room was invigorating and the enthusiasm of the teams to participate was clear. Getting the Trusts together and designing this project as a group was a really important step forwards.”
An evaluation exploring this project will be completed in Spring 2024. It is hoped this will lead to adoption and spread of the care bundle beyond the West of England.
Posted on January 3, 2023