P124 Improving safe sedation practices in bronchoscopy at a district general hospital

IntroductionProcedural sedation and analgesia (PSA) practice varies, with minimal standardisation in bronchoscopy. The British Thoracic Society published Quality Standards in 2014 to ensure high standards of care for all patients undergoing bronchoscopy.AimsIdentify areas for improvement in PSAIncrease PSA awareness amongst bronchoscopistsImprove use of safe recommended doses of sedation agentsImprove clarity of documentationMethodologyWe performed a retrospective review of 113 bronchoscopy and 59 endobronchial ultrasound (EBUS) reports (September 2019-September 2020). May 2020 was excluded due to COVID19.Three interventions were implemented:Virtual local departmental teaching to raise awareness of safe PSA.Implementation of a bronchoscopy-suite poster detailing local anaesthetic (LA) dose conversions.Introduction of specific LA fields on our online bronchoscopy reporting system.Bronchoscopy and EBUS reports were re-audited following each intervention (total 19 cases).ResultsMaximum recommended dose of midazolam in ≥70yrs (3.5mg), was exceeded in 19% of EBUS cases and 5% of bronchoscopy cases pre-intervention. Following virtual teaching, 0% exceeded maximum recommended dose.Maximum recommended dose of fentanyl (50mcg) was exceeded in 22% of EBUS and 4% of bronchoscopy cases pre-intervention. Following virtual teaching, maximum dose was exceeded in 1.6% of EBUS and 0% of bronchoscopies.Pre-interventions, 1% and 2% lidocaine use was correctly documented in 17% of procedures and instillagel use was correctly documented in 33% of procedures. Following poster implementation, 1% lidocaine use was correctly documented in 75% of procedures, 2% lidocaine use was correctly documented in 88% of procedures and instillagel use was correctly documented in 60% of procedures. Following LA-field implementation, 1% lidocaine use was correctly documented in 91% of procedures, 2% lidocaine use was correctly documented in 91% of procedures, and instillagel use was correctly documented in 66% of procedures. (figure 1)Abstract P124 Figure 1Correct documentation of LA agentsConclusionsVirtual teaching for bronchoscopists increased awareness of safe PSA, thus reducing previously exceeded recommended doses of sedatives. Implementation of a bronchoscopy suite poster, and specific recording fields for LA, has improved documentation practices. Methods introduced continue to be used in our trust’s bronchoscopy suite.ReferenceBTS Quality Standards for Diagnostic Flexible Bronchoscopy in