P220 Assessing the multi-disciplinary team response to NIV withdrawal guidelines in patients with COVID-19

IntroductionWithdrawal of NIV in COVID-19 patients at end of life presents several challenges. Patients are often more alert and have a higher symptom burden than in other end of life situations where NIV is withdrawn. The NIV withdrawal guideline, created by the centre, was updated to reflect the requirement for higher doses of anticipatory medications required for some patients in this cohort after learning from the first wave of COVID-19. The aim of this study was to review staff response to the guideline and its efficacy. MethodA questionnaire was sent to physician associates, nursing staff and doctors of all grades who have worked on the Respiratory Support Unit during the COVID-19 pandemic. This collected several types of data on staff perception of NIV withdrawal in COVID-19 patients.ResultsThe questionnaire generated 39 responses from the multidisciplinary team (MDT).97% of respondents found the withdrawal of NIV in COVID-19 challenging, and 74% felt this was more difficult in patients with COVID-19 than with other pathologies. 87% were aware of the Trust guideline regarding NIV withdrawal and 82% used it in their practice. All respondents felt the guideline was useful. While the majority of healthcare workers felt that adequate symptom control was achieved, 20% of respondents did not. This unease was further evidenced as 64% of respondents had issues or concerns regarding the use of anticipatory medications. The predominant concerns were that medication doses were started too low (35%) or too late (46%). 71% of respondents found discussions with families regarding commencing palliation challenging. All members of the multidisciplinary team found an MDT approach, including the involvement of Palliative Care colleagues, a useful source of support. The team was united in finding debriefs useful.ConclusionsOverall, this study identified that timing and dosage of anticipatory medications are a particular challenge in withdrawal of NIV in patients with COVID-19. There is scope for additional learning regarding symptom management during withdrawal of NIV. Maintaining a close relationship with the Palliative Care team provides benefit to patients, their families and staff. Further work will also focus on supporting staff in difficult conversations.