Table 3

Non-invasive ventilation (NIV) service infrastructure checklist

#SpecificationsIs it met? Y/N/plannedCommentsAction requiredTimescalePerson responsible
The purpose of this specification is to improve the quality of care provided to patients receiving acute NIV. Issues in relation to the timeliness, appropriateness, location, level of care and competency of staff treating patients with acute NIV have been highlighted.
1 Area: acute NIV should only be used in clinical areas equipped with:

  1. Continuous pulse oximetry for all patients.

  2. Continuous ECG monitoring for all patients with a clinical indication (pulse rate >120 bpm, dysrhythmia or possible cardiomyopathy).

  3. Point of care blood gas analyser within or adjacent to the NIV area.

  4. An oxygen supply

2 Leadership: there should be a clinical lead for the NIV service with time allocated in their job plan, a designated lead nurse and, where appropriate, a designated lead physiotherapist.
3 Staffing: 1:2 nursing care should be provided for all patients treated with acute NIV until NIV requirements reduce to nocturnal use only. The local operational policy should include a management/escalation plan for critically ill patients who require increased (1:1) nursing care.
4 Equipment: all ventilators used to deliver acute NIV should be designed for this purpose. There should be sufficient quantity of masks and ventilators to meet the expected demand for NIV.
5 Service capacity: designated NIV area(s) should have sufficient capacity to meet the demand for acute NIV. If NIV starts in other areas, NIV trained staff should remain with the patient during delivery of NIV; the same monitoring should be provided and transfer to a designated NIV area should occur within 4 hours.
6 Governance:the NIV service should have:

  1. A locally developed NIV protocol (based on published best practice guides) uniformly applied across all areas.

  2. A process of regular audit (continuous rolling audit is recommended), including participation in national audits.

  3. A robust morbidity and mortality process including rapid review of all inpatient deaths of patients treated with (or considered for) acute NIV including a respiratory physician or intensivist. Cases in which an omission in care is likely to have contributed to an avoidable death should be investigated as serious incidents.

  • Adapted from BTS/ICS Guidelines for the Ventilatory Management of Acute Hypercapnic Respiratory Failure in Adults (March 2016) and National Confidential Enquiry into Patient Outcome and Death (July 2017) Inspiring Change – Acute Non-Invasive Ventilation.