Emergency guidelines and front of neck access kit quality-improvement project: Are they there?

In an emergency, immediate access to essential equipment and guidelines is critical. This quality-improvement project (QIP) aimed to standardise the availability of anaesthetic emergency guidelines and front of neck access (FONA) equipment, in all areas where anaesthesia is delivered at a tertiary teaching hospital. Methods A single-centre, prospective QIP was performed between October 2020 and January 2021, after equipment redeployed to intensive care unit (ICU) areas during the pandemic surge was returned to theatre. A previous QIP had stipulated the locations for emergency guidelines and FONA kit (on the rear and in the bottom drawer of every anaesthetic machine, respectively). LifeQI web platform was used for project management, with data collected using an online pro forma. The standards for the QIP were: 1. RCOA Guidelines for the Provision of Emergency Anaesthesia Services (GPAS) 2020 [1] a. The following policies should be immediately and reliably available i. Guidelines for the management of anaesthetic emergencies ii. Difficult airway management 2. DAS 2015 Difficult Intubation Guidelines [2] b. The technique relies on the correct equipment being immediately available i. Scalpel with number 10 blade ii. Bougie with coude (angled) tip iii. Cuffed endotracheal tube, size 6.0 mm, lubricated Results Thirty-five anaesthetic machines were inspected. Twenty-nine (83%) did not have emergency guidelines attached and 23 (66%) did not have a complete, standardised FONA kit. All FONA kits present were obscured by clutter. The following actions were undertaken: consultation to rationalise guideline pack contents and format, choosing guidelines containing familiar visual cues of national protocols;design and assembly of laminated guideline packs, attached to the rear of all anaesthetic machines using quick release cable ties;standardised FONA kits placed in the bottom drawer of all anaesthetic machines, all clutter removed;drawers labelled with standardised 'Emergency FONA kit' signage;and operating theatre staff informed of the new standard. Discussion This QIP identified the absence of emergency guidelines and FONA equipment in anaesthetic machines returned after ICU redeployment during the 2020 COVID-19 pandemic. This failure may be widespread during a global pandemic and the anaesthetic community should be mindful of this easily rectified threat to patient safety.