LAUSR

Background An unexpected Difficult Airway (DA) is a recognized emergency in anesthesia for which protocols exist (Frerk, Mitchell et al. 2015). It is a rare but potentially fatal emergency for the patient. Within the Intensive Care Unit (ICU) this is an even rarer event. The possibility of latent safety threats (LST) is high and potentially fatal. Prior to the simulated scenario there have been changes made to the local protocol for managing an unexpected difficult airway and a new algorithm has also been introduced to more junior members of the Multi-Disciplinary Team (MDT). Summary of work We designed an in situ simulation scenario to address the unexpected difficult airway. We asked the participants to use all the equipment which they are familiar with and use the protocols which they are aware of. This scenario was first tested at the ICU Odense University Hospital Denmark. Then adjusted and run at ICU at Guys and St Thomas Hospital London United Kingdom. There was a post simulation questionnaire to assess the knowledge gained in both Non Technical, and Technical Skills. To capture the LSTs, the scenario was observed by an anesthetist with expertise in DA. Results A total of 12 participated in the scenario, 8 Nurses, 2 Registrar and 2 others. They had an average of 3.42 years of ICU experience. Participant described an overall gain in knowledge off the difficult airway from an average of 4,66 to an average of 5,58 (table 1). Furthermore there was a slight tendency towards a gain in self-confidence when doing intubation. Do to the low amount of participants we did not calculate a P value.Abstract P12 Table 1 1 totally disagree and 7 totally agree Average (Range) Prior to todays in situ simulation I had a good knowledge of difficult airway management: 4,66(4–6) After todays in situ simulation I have good knowledge of difficult airway management: 5,58 (5–7) Prior to todays in situ simulation I felt confident in my role of intubation: 5,25 (4–7) After todays in situ simulation I feel confidence in my role of intubation: 5,5 (4–7) I feel that in situ simulation have increased my knowledge about difficult intubation 5,66 (5–7) I feel In situ simulation has increased my knowledge of the difficult airway algorithm 5,91 (5–7) 13 latent safety threats were documented doing the scenario. Discussion Our study suggests that the use of in situ simulation to train rare and potentially lethal situation will help increase the staff’s self-confidence. This correlate with the finding of Patterson et al (Patterson et al., 2013). Furthermore a number of LST was emerged. However the number of participants and the number of repetitions are too small to generalize. Conclusion This data indicates that it is possible to use In situ simulation to implement new protocols and guidelines for procedures, and to increase self-confidence, knowledge and skills. It also indicates that In situ simulation is a valuable tool to emerge latent safety treats without any patient coming to harm Further studies are needed to support this. References Frer K C., Mitchell V., Mcnarry A., Mendonca C., Bhagrath R., Patel A., O’Sullivan E., Woodall, N., Ahmad I. 2015. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. BJA: British Journal of Anaesthesia, 115, 827–848. Patterson M. D., Geis G. L., Falcone R. A., Lemaster T., Wears RL. 2013. In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. BMJ Qual Saf, 22, 468–477.