Abstract
Background: BiPAP is used on 3 different areas providing acute therapy at Newham University Hospital: A&E, ACU and ITU. Trust's BiPAP guidelines were introduced and loaded on the hospital intranet in December 2008. We compared adherence to guidelines during two three month periods in January to March 2009 (Period 1) and September to November 2009 (Period 2) and compared those two time frames outcomes.
Method: A proforma was developed and data acquired from the patients' notes and laboratory results. We compared the Trust's BiPAP guidelines with the data acquired for both periods.
Results: During Period 1, 70% of patients started on BiPAP (n=19) were correctly indicated for treatment, compared with 83% (n=23) during Period 2. 48% were started on BiPAP in ACU, 43% in A&E during Period 1, whilst 40% were started in ACU and 35% in A&E during Period 2. BiPAP initial settings were correct for no patients in period 1 and 14% of patients in period 2. 35% of patients in Period 1 had decisions fo ceiling of treatment documented, compared with 65% in Period 2. Oxygen was prescribed for 30% of patients during Period 1 and 17% of patients during Period 2. Outcomes showed that 45% patients made a full recovery in Period 1 and 75% during Period 2.
Conclusion: At Newham, introduction of local BiPAP guidelines helped in improving outcomes. There is poor evidence of documenting decisions on ceiling of care if BiPAP fails. Oxygen prescribing was very poor through both periods.
Recommendations: We need to encourage and educate all doctors and nursing staff using BiPAP to refer to the guidelines. A proforma has been developed to aid this and encourage early decision making and good documentation.
- © 2011 ERS