An audit of resuscitation suction equipment in clinical areas at six hospitals across South Yorkshire

Abstract

Suction is a basic requirement for airway management and devices should be available in all clinical areas for emergency use [1]. Equipment failure is responsible for a delay in the commencement of effective cardiopulmonary resuscitation in up to 18% of arrest calls [2]. This audit was designed to evaluate suction equipment availability and assess its readiness for immediate use with the aim of reducing resuscitation delays and improving patient safety. Methods We developed simple criteria and standards from the available guidance [1]: (i) criterion: suction equipment should be complete and functional; (ii) standards: 100% of suction units should have a Yankauer tip; 100% of suction units should have correct tubing; 100% of suction units should be properly connected; and 100% of suction equipment should work. Audit approval was received at each of the six hospitals and data collection was standardised using a guide and proforma to ensure comparability. The audit was conducted as a spot check with the consent of the nurse in charge of each area. Minor faults were corrected where possible and reported to the appropriate member of the ward staff. In addition, major faults were reported to medical engineering and the resuscitation officers. Data were collated and analysed using a spreadsheet programme. Results A total of 3560 suction units were inspected at six hospitals. Of these 1134 (32%) met the standards to be immediately ready for use. If critical care areas were excluded, the number achieving the standards fell to 778 (24%). From a total of 176 portable suction devices, 98 (56%) were fully set-up and operational. The six sites showed a wide variation in functional suction units with (mean (SD [range]) of 39% (18% [15-65%]). There was no significant difference between medical and surgical wards but critical care areas generally achieved 100%. Discussion We demonstrated that a cross-section of hospitals do not maintain an adequate level of suction equipment. This was not restricted to wall suction as just under half the portable devices were inadequately set up. It is interesting that the majority of the hospitals already had formal equipment checking systems. Although not formally recorded as part of the audit we observed that faults were caused by a variety of problems including intermittent equipment availability, poor training and a shortage of designated responsible staff. In some cases reorganisation or change in clinical priorities had resulted in the removal of equipment from the bedside. In others, insufficient funds prohibited the purchasing of portable suction units. A lack of centralised funding and no overall responsibility for resuscitation equipment appear to be major factors in these issues. Investment in equipment, designated responsibility, simple training and spot checks are required to make improvements.