G16 Development of a checklist for emergency paediatric intubations in a district general hospital

Abstract

AimsThe unexpected death of a four month old baby during an emergency endotracheal intubation in our district general hospital highlighted the critical need to improve the process and safety of emergency paediatric intubation. A root cause analysis investigation into the event identified multiple factors contributing to this unfortunate outcome with human factors playing a significant role: A poorly structured intubation process with poor communication and role division between the paediatric and anaesthetic teams was significant. There is already strong evidence for the value of checklists in reducing errors in procedures. We therefore designed a checklist to be used in our district general hospital in emergency paediatric intubations to try to improve patient safety.MethodThe checklist was designed to include prompts for consideration of patient, equipment and team factors. It is to be used as a ‘time-out’ before induction is attempted to improve team members’ situational awareness and ensure all necessary preparations are made. It is on a single-sided A4 sheet that is completed in a tick-box format then filed in the patient’s notes. The first stage involves ensuring that the patient’s condition is optimised, including oxygenation and haemodynamic status. The next stage checks that appropriate monitoring is applied to the patient and all necessary equipment and medications are to hand. Clearly identified roles are then allocated to team members. A back-up plan for difficult intubation is then identified and the relevant equipment accessible. After these checks, induction and intubation commences. The checklist was introduced to the paediatric and anaesthetic teams and used over a three month period before a questionnaire was sent out for users to provide feedback on the checklist.ResultsThe checklist was well received by both the paediatric and anaesthetic teams and received strongly positive feedback. Results from the questionnaire reported that it was very useful, creating an important structure and focusing everyone’s attention. This helps to calm the situation, which can become highly fraught, and seems to reassure the team, patient and parents.ConclusionA checklist appears to be a valuable tool for improving team communication and creating structure during emergency endotracheal intubation in paediatrics.