PP2 Multiprofessional airway training: a crucial component of safe teamworking in obstetrics

Abstract

Background Airway management during emergency obstetric anaesthesia is associated with higher rates of difficulty and failed intubation.1 This occurs in a high-intensity team setting and involves multiple professional groups. Although team training is used successfully for other obstetric scenarios, this does not commonly cover airway emergencies.2 We aimed to introduce regular simulation-based multiprofessional training at University Hospitals Bristol and Weston NHS Foundation Trust specifically designed to encourage team working during airway emergencies in obstetrics. In particular we aimed to identify and reduce the impact of latent safety threats by using in-situ simulation. Summary of Work We identified regular 45-minute sessions to fit with existing staff training to allow attendance by multiple professions when theatre usage was minimal. Obstetricians, midwives, theatre practitioners and anaesthetists were invited to attend, and the sessions were held in the emergency obstetric theatres. The simulated scenario involved both ‘Can’t Intubate Can Oxygenate’ and ‘Can’t Intubate Can’t Oxygenate’ events during an emergency caesarean section, culminating in scalpel cricothyroidotomy on an improvised front-of-neck trainer. The scenario was specifically designed to involve multiple professional groups, with an emphasis on good teamworking and communication which was further developed through post-simulation debriefing. Summary of Results Over 2 pilot sessions there were 10 participants from the multiple professional groups and feedback was positive. In particular non-anaesthetists commented on the benefits of simulating an airway emergency they were otherwise unfamiliar with. Specific areas for discussion included the importance of making team-based decisions in advance regarding failed airway management (i.e. proceed vs. abandon procedure), and the importance of good visibility of the emergency intubation checklist and protocols in the obstetric theatres. This has led to relevant cognitive aids being attached to the video laryngoscopes used in airway emergencies. Discussion and Conclusions Multiprofessional obstetric airway training appears to be well received and beneficial to all participants. In particular our sessions benefited from the in-situ setting and input from multiple professional groups. We have written a training pack designed to allow easy replication of this session, and intend to run this on a regular basis. Materials have been designed to support facilitation by individuals less experienced in simulation-based education, and we hope to empower others from multiple professional groups to deliver this in future. Recommendations Similar training should form an essential component of wider obstetric team training, and could be facilitated by any member of the multiprofessional team with appropriate support and experience. References Cook TM, Woodall N, Frerk C. A national survey of the impact of NAP4 on airway management practice in United Kingdom hospitals: closing the safety gap in anaesthesia, intensive care and the emergency department. BJA: British Journal of Anaesthesia 2016 Aug 1;117(2):182–90. Winter C, Crofts J, Draycott T, Muchatuta N, editors. PROMPT course manual. Cambridge University Press; 2017 Oct 19.