20 rural Emergency Departments (ED’s) across Western NSW have the capacity to delivery non-invasive ventilation (NIV) to critically unwell patients utilising the Drager Carina. This device was implemented a number of years ago, however with the dynamic workforce shifts since COVID there has been less experienced nurses working across these ED’s. With the lack of familiarity with delivering NIV comes risk associated with in appropriate settings, layer upon this facilities with no medical coverage on site and a reliance on virtual critical care services, the chances of adverse events was beginning to reach maximum levels.
As adverse events were occurring the usual mitigation strategies were put in place, rigours governance, supplemental nursing education for both virtual and facility based nurses and pictorial quick reference guides. When adverse events continued to be reported an alternative approach was required.
Using the behaviour change wheel it was apparent that a combined approach of fiscal measures and regulation was required to address these issues. Patient safety partners collaborated with the LHD CNC to develop a “Safety Pause” tool which was led by the vCare nurse ahead of each time NIV was commenced. The “Safety Pause” is tool which addresses and double checks all the high risk stages in setting up and commencing NIV in a rural sector facility with virtual nursing support.
The implementation of the “Safety Pause” tool has seen a 100% decrease in reported incorrect NIV settings, incorrect circuit set up and adverse events related to initiation and management of NIV.
The “Safety Pause” tool also includes components of building confidence and capacity amongst clinicians who may have never used the device in clinical practice. This script based check list can be further applied to other critical care interventions.