TY - JOUR T1 - Effect of a structured education programme on the documentation of “ceiling of care” for patients with acute hypercapnic respiratory failure (AHRF) requiring non invasive ventilation (NIV) JF - European Respiratory Journal JO - Eur Respir J VL - 38 IS - Suppl 55 SP - p2080 AU - Shiva Bikmalla AU - Bethan Barker AU - Ajit Thomas AU - Ben Beauchamp AU - Asad Ali AU - Mudassar Aslam AU - Dev Banerjee AU - Rahul Mukherjee Y1 - 2011/09/01 UR - http://erj.ersjournals.com/content/38/Suppl_55/p2080.abstract N2 - Introduction: With greater use of ward-based NIV, early documentation of decisions regarding ceiling of care of these patients is assuming greater importance. Nava et al. [1] showed that ceiling of care documentation was low in this group of patients. We conducted a survey of documentation of “ceiling of care” at our 11-bedded ward-based NIV unit in Birmingham, UK, providing acute medical services to a population of over 450000 to assess the effect of a targeted rolling education programme for the caregivers and the use of a standardised protocol.Methods: Retrospective case note analysis of all patients commenced on acute NIV for AHRF between 1st January 2009 and 31st January 2010. Data relating to documentation of ceiling of care for patients, NIV outcome and mortality were collected after the educational intervention to improve practice.Results: Over the 13 month period of data collection there were 264 NIV episodes for AHRF. Ceiling of care was documented in 165 patients (62.5%). NIV treatment failure occurred in 59/264 (22%). Eleven of 264 patients (4%) were admitted to ITU during this admission episode. The overall in-hospital mortality for the entire group was 12.8%.Conclusions: Documentation of ceiling of care in NIV patients can significantly improve with the increase in awareness among caregivers following the introduction of a rolling education programme and the use of a standard protocol.Reference:1. End of Life decision making in Respiratory Intermediate care units: a European Survey. Nava S, Sturani C, Hartl S, Magni G, Ciontu M, Corrado A, Simonds A. Eur Respir J. 2007 Jul;30(1):156-64. ER -