AIRWAY MANAGEMENT IN THE EMERGENCY DEPARTMENT Document Reference Document status Target Audience [TO BE PROVIDED BY CORPORATE AFFAIRS] Draft All staff Date Ratified Ratified By Release Date Review Date Sponsor Version Date of Amendments Author Update comments 1.0 22/07/2014 Dr Peter Hersey 2.0 9/9/2014 Dr Peter Hersey 2.1 2/12/14 Dr Peter Hersey Downgraded from policy to clinical protocol 5.3 prior knowledge of 6.2 support. They should have no other duties. 7.2 resuscutation department changed to resuscitation room 1
CONTENTS Section Page 1 Introduction 3 2 Purpose & Scope 3 3 Duties 3 4 Definitions 4 5 Responsibilities 4 6 Team membership 4 7 Resource 5 8 Handover 5 9 Dissemination, Implementation and Training 5 10 Consultation, Review and Approval/Ratification 5 ` 2
1 INTRODUCTION 1.1 City Hospitals Sunderland NHS Foundation Trust ( the Trust ) aspires to deliver its vision of Excellence in Health, Putting People First, through the highest standards of corporate behaviour and clinical competence. It also aims to ensure safe, fair and equitable procedures are applied to all organisational transactions, including relationships with patients, public, staff, stakeholders and the use of public resources. 1.2 Emergency Airway management must be provided in a safe and effective manner. This clinical protocol outlines the responsibilities of staff in instituting airway management, and the route for escalation to more complex management. 2 PURPOSE & SCOPE 2.1 The purpose of this protocol is to: Define the level of management expected of staff. Define the routes of communication in seeking advanced or definitive airway management. Define the responsibilities of the Trust in supporting professional development. 2.2 The protocol does not define clinical management, as these decisions should be made in the best interests of the patient by the clinical team. 2.3 The protocol applies only within the emergency department. 2.4 The protocol does not apply to the emergency management of tracheostomies or to the cardiac arrest situation. 2.5 The protocol applies to all ages. 3 DUTIES 3.1 Board of Directors The Board of Directors are responsible for approving a framework to best support airway management. 3.2 Chief Executive The Chief Executive is responsible for ensuring adequate staffing and resource for airway management 3.3 Clinical Governance Committee The clinical governance committee is required to ensure review and rigour of this protocol. 3.4 Heads of Service 3
Heads of service are responsible for ensuring this protocol is maintained in practice. 3.5 All Trust staff/employees (including locum, agency staff, honorary contract holders, contractors and volunteers) All involved with airway management in the emergency department must be aware of and understand this protocol. 4 DEFINITIONS Emergency airway management is the opening of an obstructed airway. Basic airway management includes the triple airway manoeuvre, insertion of airway adjuncts (oropharyngeal and nasopharyngeal airways) and insertion of a laryngeal mask airway. Advanced airway management is the insertion of an endotracheal tube or any airway management that necessitates the use of drugs or medications. 5 RESPONSIBILITIES 5.1 Any staff member is expected to work within the limits of their competence when undertaking emergency airway management. Distinction is not made between job roles. 5.2 Every staff member has an obligation to perform emergency airway management if it is required and they are competent. 5.3 Advanced airway management should be undertaken only by, or with the knowledge of, members of the critical care, neonatal or anaesthesia medical teams. 5.4 All staff members who have attended basic, intermediate or advanced life support courses would be expected to provide basic emergency airway management in the majority of cases. 5.5 It is the responsibility of the person instituting emergency airway management to ensure its effectiveness. If the management is ineffective it is that person s responsibility to call for help. 6 TEAM MEMBERSHIP 6.1 Whenever basic emergency airway management is being undertaken, at least two members of clinical staff should be dedicated to the patient. A patient with an obstructed airway should be under the care of a senior doctor. 4
6.2 The institution of emergency advanced airway support requires a dedicated and suitably competent member of staff to assist the team member providing that support. 7 RESOURCE 7.1 Any patient requiring emergency airway management should be cared for in the resuscitation area of the emergency department. 7.2 The resuscitation room should have freely available the drugs, monitoring and equipment for emergency basic and advanced airway management that will be required in the majority of cases. There should be rapid access to all airway equipment available within the theatre suite. 8 HANDOVER 8.1 The patient remains under the clinical responsibility of the emergency department whilst within the resuscitation room. 8.2 A written and verbal handover of the patient should include details of airway management. 9 DISSEMINATION, IMPLEMENTATION AND TRAINING 9.1 Dissemination To the Medical Director, Chief Executive and Director of Nursing by Email. To the Clinical Directors and Matrons for Theatres and Emergency Medicine by Email. To clinical teams via. Team Brief 9.2 Training Clinical Directors to ensure all staff within the directorate are aware of this protocol. College Tutors to ensure this protocol is outlined as part of the departmental induction process. 10 CONSULTATION, REVIEW AND APPROVAL/RATIFICATION 10.1 Consultation Clinical Directors for Theatres and Emergency medicine. Executive Committee Governance Committee 5
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