In 2012, in response to the findings of the 4th national audit project of the Royal College of Anaesthetists of Great Britain (NAP4), Ysbyty Gwynedd in Bangor, North Wales developed a checklist to be used by staff prior to all emergency intubations / rapid sequence inductions in the ICU / ITU and emergency department (ER). We have validated and audited the checklist and have it is now a standard practice in Ysbyty Gwynedd. We have developed some training presentations and a training video (on you tube) which we are happy to share freely through this blog. The checklist is adapted from one published in NAP4. The checklist we use is also available on this blog. Please feel free to browse and use these. No matter how experienced or senior you are, you are human and prone to lapses and error. We all forget basic things occasionally under duress. Most of the time the consequences are insignificant but during an emergency intubation the consequences of forgetting to consider a back up plan, or forgetting the capnograph could result in disaster. A simple checklist is free and simple to follow. It doesn't need to be time consuming or patronising. In fact we spent a lot of time working on the checklist to make sure it was user friendly. (The version we adopted was about the 10th version.) If your hospital / department are not currently using any form of verbal checklist for emergency intubations - why not? Are you confident that all your emergency intubations are perfect? Do you think there could be room for improvement? To quote Atul Gawande "Better is possible. It doesn't take genius, it takes diligence" Take our checklist - adopt it for your own hospital / department and start using it.
Our emergency induction checklist is now a standard practice for all emergency intubations in the emergency department and HDU / ITU here at Ysbyty Gwynedd in Bangor, North Wales.
A recent audit found that most users find that it is very helpful and does not significantly delay the intubations.
I am also glad to hear that it the you tube video that we made has been used for mandatory training in the Gold Coast Hospital, Queensland, Australia (where oddly enough I used to work in 2002). Great minds think alike!
We have also had an abstract published after our poster was shortlisted at the DAS conference last November. The abstract can be accessed via the anaesthesia online website:
Poster for presentation of our emergency induction checklist study at the annual conference of the Difficult Airway Society, Cardiff (21st-23rd November 2012) by Dr Farbod Babolhavaeji (ACCS CT2 trainee in Emergency Medicine)