Clinical Pathway Difficult Airway in 13th Health Department in Denia Hospital (Spain)

Francisca Llobell, Patricia Marzal, Remedios Pérez, Daniel Paz, Juan Cardona.
Cediva Dénia Training Center, Anesthesia and ICU Department
Dénia Hospital
Spain
1 .- Goal

Planned and coordinate the sequence of medical procedures, nursing and administrative
capacities necessary to achieve maximum efficiency in the management of patients with
difficult airways. Adapt the plan to the clinical information system: Cerner Millennium
(Figure 1)

2 .- Design

We are a multidisciplinary team to define the phases and actions to be undertaken by each
sector in each of them. Appointment of a committee responsible for the process.
3 .- Setting

Inclusion of patients in the Clinical Pathway Difficult Airway (CP DA), after a thorough
history and systematic examination, informed consent, the active diagnosis coding an alert
that identifies the patient with a wrist (Figure 2) and notifies the responsible committee.
Activates the patient preparation and material and human resources to manage their VA,
which will lead to a customized management plan aimed at establishing a safe airway.
Clinical record access, control extubation and extubation of the case. The end of the clinical
pathway involves a case review by the committee, analysis of indicators, material
replacement and issuance of a document of difficult airway for the patient (Figure 3)
4 .- Results

The set of actions in each phase to be completed by each of the actors are summarized in
the temporary array.(Table 1)
5 .- Conclusions

The best management of VAD is the anticipation, systematic assistance to the VA in these
patients is key to minimizing delays, better use of available resources and optimize the
process forcing the organization to be targeted to the same; this increases patient safety.
Figure 1: Cerner Millenium
Table 1: Temporary Array Clinical Pathway Difficult Airway

Phases INCLUSION ACTIVATION PREPARATION PRE-ACCESS ACCESS EXTUBATION VIGILANCE END OF

Professionals POST PROCEDURE
NURSING - BMI Safety - Monitoring - Knowledge. - Safety
- Gives Informed Measures - Collaborates with - Training. measures.
Consent for DAM the plan - Meticulous
care
AIRWAY - Assessment. - STAFF on - Re-assessment. - Assessment of - Aim: Safe Airway. - Extubation - Continual - Information
OPERATOR - Information alert. - Revision Anxiolysis . - Technique strategy assessment. updated
- Education - Notifies final - Approach plan. developement. -Decision to - Supervised
- Documentation operator. - Start plan -Documentation. delay discharged.
- Photograph - Design of the
plan

SYSTEMS - Register - Messages -Documentation - Registry

- Documentation center.
- Notifies
committee.
PATIENT - Accepts Contact - Keep safe - Shows
- Consents with health updated card
- Declares system.
- Commitment - Notifies.
to fill in
documentation
ADMISSION Scanning and - Identifies - Protocol. - Availability - Accessible - Aldrete
storing of arrival. - Informed protocols and protocols sedation
documents. - Wrist ring. consent. documentation assessment
- Advance care - HCAD_ Living
directives. Will
- Scheduling
MEDICATION - Avoid CNS - Antisialogogue - Local anesthetics -Approach: - Antagonists - Avoid CNS
depressants - AntiH2 - Vasoconstrictors conscient or after - Anti- depressants
- Prokinetic induction inflammatory
AUXILIARY - Shaving - Ready-to-use kits - Knowledge. - Orders
NURSE - Training. material.
STERILIZATION - Material - Material available - Material available - Material - Revision and
available available: bridge restoring
device
LOGISTICS - Material - Intubation trolley - Extubation - Restoring
available table
COMITTEE - Receives - Available - Available and - Available - Analysis
notification support - Reassessment
Figure 2: Difficult Airway Bracelet Patient

Figure 3: Card Patient in 13th Health Department Dénia Hospital (Spain)