Non-Invasive Ventilation (NIV) in Level 3 areas at a NHS Foundation Trust: A quality improvement project

Background: The delivery of NIV using dual limb ventilators is complex and can lead to problems, such as trigger sensitivity and leak. Due to this, and the introduction of a different ventilator on our unit, a quality improvement project was carried out to review aspects of clinical governance focusing on risk management, education and training. Objectives: - Review incident reports and identify themes - Assess staff confidence and competence Method: Review of incident reports for NIV in level 3 areas for 24 months pre- and 19 months post- introduction of new ventilators. A questionnaire was developed from current literature to assess staff confidence and competence.  Responses were captured via survey monkey and hard copy.  Competency questions were marked against a best practice answer based on existing guidelines. Results: Reported incidents increased by 100% after introduction of the new ventilators including themes of pressure areas, equipment, confidence and troubleshooting.  Staff responders to the questionnaire included doctors, nurses and physiotherapists (n=52).  The matrix demonstrates the interaction between confidence and competence scores. Conclusions: Themes from the questionnaire and incident reports will be used in the production of a new clinical guideline and staff training package. The methodology will be repeated in the future to evaluate change and identify areas for further work.