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20 Introducing guidelines for the management of terminal airway events in a hospice setting
  1. Amy Taylor,
  2. Despoina-Elvira Karakitsiou and
  3. Clare White
  1. Northern Ireland Medical and Dental Agency, Northern Ireland Hospice


Introduction The incidence of terminal ‘airway events’ (obstruction and haemorrhage) in hospice setting is not known. In our hospice, 75% of medical staff have looked after patients with altered airways and 30% have dealt with airway emergencies. Most do not feel confident dealing with such emergencies.

Methods All medical staff in the hospice were invited to anonymously complete a survey on their confidence dealing with tracheostomy patients and airway emergencies. Guidelines on management of airway emergencies were developed after literature review and agreed by the multidisciplinary team. They were then presented to medical staff in educational sessions, with a repeat survey to evaluate staff levels of confidence.

Results There were 11 and 8 respondents in the pre- and post-session surveys respectively. Respondents came from all grades (Internal Medical Trainee, Specialty Doctor, Specialty Registrar, Consultant). Prior to guidelines and training, 25% of staff felt not confident recognising the components of tracheostomy tubes, which improved to 75% feeling moderately confident . After education, 75% felt moderately or very confident distinguishing the differences of tracheostomy and laryngectomy (previously 50%). Levels of anxiety reduced post-education (58% pre and 12.5% post education), with levels of confidence dealing with terminal airway events significantly improving (8% pre- versus 75% post- education).

Conclusions Introduction of guidelines for airway emergencies in a hospice setting and educational interventions have improved the level of knowledge and confidence of medical staff. Ongoing education is necessary to ensure knowledge and confidence remain high. These guidelines have been included in induction for all medical staff. Impact and utility of guidelines will be further evaluated when staff apply them in real events.

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