1. National Audit Project Four NAP4

2. What is NAP4? A national audit of major complications of airway management in the UK

3. Why? To determine the incidence of serious complications of airway management in UK anaesthetic practice To look for themes and to learn from adverse events

4. Number of Complications _________________________________________________________________________________ Number of Airway Interventions Within a given time period Incidence?

5. How many anaesthetics are performed per year in the UK? Not known No data = No denominator Snapshot of current practice needed

6. NAP4 needs two phases Phase 1 A snapshot of practice Over a 2 week period During September 2008 Provides denominator Phase 2 Study of complications Over one year 01/09/2008 - 31/08/2009 Provides numerator Number of complications _________________________________________________________________________________ Number of Airway Interventions

7. NAP4 needs two phases Phase 1 A snapshot of practice Over a 2 week period During September 2008 Provides denominator Phase 2 Study of complications Over one year 01/09/2008 - 31/08/2009 Provides numerator Number of complications _________________________________________________________________________________ Number of Airway Interventions

8. Phase 1- The Snapshot Data Collection All anaesthetics in a hospital Over the same 2 week period Submit data on clinical activity Number of general or regional anaesthetics Airway management of cases under GA All hospitals in the UK Co-ordinated by the Local Reporter

9. Local Reporters Used for NAP3 – Central neuraxial blockade Have an essential central role Disseminate information Collect data - snapshot Support local anaesthetists Aid reporting of adverse airway events in phase 2

10. Phase 2 –Airway Complications Data Collection Starts 1 st September 2008 Runs for 1 year Notify RCoA /Tim Cook by email Online data submission

11. What sort of Complications? Inclusion Criteria Death Brain damage Emergency surgical airway ICU admission resulting from an airway management complication

12. Emergency Surgical Airway Includes Emergency Cricothyroidotomy –Needle –Cannula Emergency surgical airway –Cricothyroidotomy –Tracheostomy

13. Example cases for inclusion Post extubation stridor requiring re-intubation and ICU admission Elective ventilation following hypoxic cardiac arrest due to an airway problem during anaesthesia ICU admission following aspiration of gastric contents during an operation ICU Admission Resulting from an Airway Management Complication

14. Example of cases for exclusion ICU Admission for unrelated reasons ICU Admission because HDU was full HDU admission following aspiration of gastric contents with complete resolution

15. When does it start? Snapshot of current practice –2 week period September/October 2008 One year data collection process –01/09/2008 to 30/08/2009

16. Airway Problems Elsewhere Meeting Inclusion Criteria Intensive Care Unit – Inform NAP4 Emergency Department – Inform NAP4 Hospital wards - Do not inform NAP4 Pre-hospital care - Do not inform NAP4 If an anaesthetic is involved Anywhere in the hospital – Inform NAP4

17. Notification of Events Anyone may inform the college of events Inform the RCoA lead –Tim Cook tcook@rcoa.ac.uk tcook@rcoa.ac.uk A username will be issued to enable on- line data submission via the DAS web-site Data submission is required to be anonymous

18. All you need to remember is.. If you know of an airway problem resulting in: –Death –Brain damage –Emergency surgical airway –ICU admission resulting from an airway management complication Inform Tim Cook tcook@rcoa.ac.uktcook@rcoa.ac.uk Send no patient details

19. Approval The process has been approved by NRES National Research Ethics Service PIAG Patient Information Advisory Group CMO UK Chief Medical Officers

20. Supported by Royal College of Anaesthetists Difficult Airway Society National Patient Safety Agency Association of Anaesthetists of Great Britain and Ireland, Association for Peri-Operative Practice Association of Paediatric Anaesthetists College of Emergency Medicine College of Operating Department Practitioners Intensive Care Society Intensive Care National Audit and Research Centre Obstetric Anaesthetists Association Paediatric Intensive Care Society Paediatric Intensive Care network All Chief Medical Officers Medical Defence organisations

21. More Information – RCoA Web-site

22. More Information - DAS Web-site

23. More Information RCoA Bulletin September 2008 Anaesthesia News September 2008

24. More Information - Posters Appearing soon! Anaesthesia departments Intensive Care Units Emergency departments

25. Thanks for your support The End