6370 Intubating on precious time

Objectives The neonatal team at the local neonatal unit (LNU) observed that intubations requiring pre-medication for mechanical ventilation and/or surfactant administration, had significant delays during the process. A service evaluation was carried out to look at the following: Time interval between decision to intubate and completion of intubation Causes of time delays during intubation Whether documentation met the standards set by the East of England neonatal network? Methods Using BadgerNet, the details of all babies admitted to the LNU and intubated, between 1st January 2021 and 31st August 2022 were collated. This totalled 40 babies, excluding babies intubated before transfer. A retrospective review of the notes was conducted to examine the following documentation, based on the East of England neonatal network guideline on endotracheal intubation.¹ Reason for intubation Date and time of decision to intubate Time drugs prescribed and administered Time intubated Number of intubation attempts Size of endotracheal tube (ETT) and length at lips Post-intubation chest x-ray (CXR) and changes made if necessary Results 18 babies were intubated electively, using premedication, and 22 were intubated as an emergency without pre-medications. Of the emergencies, 3 were re-intubations carried out on the LNU for blocked ETTs, whereas the rest were carried out in theatre or the delivery room. For the elective intubations, the median time between decision and drug prescription was 20 minutes, 25 minutes from prescription to administration of medications and 6 minutes from drug administration to completion. The median time it took to intubate a baby was therefore 51 minutes, compared to a median of 7 minutes to complete an emergency intubation. Finally, the documentation of neonatal intubation was not compliant with the standards, particularly the time and date of decision to intubate. Conclusion With the support of a multidisciplinary team; medical, nursing and pharmacy, several ways to improve the process have been introduced. Firstly, a prescription sticker has been created so that medications for intubation are prescribed for all high dependency babies on admission to the LNU. Secondly, a weight banded chart for pre- intubation medications has been created to aid preparation, prescription and administration of medications. Lastly a documentation sticker has been created for the medical notes to meet the regional network guidelines.¹ These changes will be summarised in the form of a Local Safety Standard for an Invasive Procedure (LOCSSIP) which will undergo regular guideline review. Reference Endotracheal Intubation, East of England Neonatal ODN, 2022.