Decision tree for setting up BiPAP for acute hypercapnic respiratory failure

Summary

This decision tree, used at the Brighton and Sussex University Hospitals NHS Trust, was developed as a ‘quick reference’ aid for nurses setting up non-invasive ventilation (NIV). It highlights key settings and signposts users to the full trust policy for more detailed explanation. It is adapted from the British Thoracic Society guidelines for acute NIV. 

Content

Key learning points

• The decision tree is laminated and attached to all machines in the trust. It is it also available electronically on the trust’s information net and within the NIV policy document. 
• The idea is to make it as straightforward as possible whilst not omitting key requirements. 
• Feedback from nurses using this has been very positive, they particularly like the colour coding and the flow chart design which helps clarify different settings for different patient groups.
• During training, emphasis is put on knowing where to find this information, rather than on memorising all the settings and trying to recall these in a potentially stressful environment with a deteriorating patient.
• The paperwork we use to document NIV observations also includes the decision tree integrated in, as staff are now familiar with this design, improving consistency and standardising care.

Please contact Kat Dalton if you are planning or implementing a similar project, she would love to hear about it and share resources and ideas.

BiPAP decision tree.pdf