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Quality improvement report
Management of catastrophic haemorrhage in palliative head and neck cancer: creation of a new protocol using simulation
  1. Paul Sooby1,2,
  2. Abdurahman Tarmal1,
  3. Richard Townsley1
  1. 1ENT, NHS Ayrshire and Arran, Ayr, UK
  2. 2ENT, Queen Elizabeth University Hospital, Glasgow, UK
  1. Correspondence to Dr Paul Sooby; paulsooby{at}doctors.org.uk

Abstract

Catastrophic haemorrhage or carotid blowout a rare but devastating consequence of head and neck cancer. In most cases, this represents a terminal event, and the patient is prescribed pre-emptive analgesia and anxiolytics. There is anecdotal evidence that due to the time taken to prepare the medications that patients do not receive these drugs prior to death. We aimed to identify the drug to patient time using simulated catastrophic haemorrhage simulations. We used the current protocol for this and also proposed a new grab-bag with preprepared anxiolytic and anagelsic medications. Each scenario was repeated 16 times. The mean time for drug administration using the current policy was 124 s compared with 48 s when the grab-bag was used (p<0.01). The new protocol also reduced the variability in the drug to patient time. We aim to implement this new protocol on the head and neck ward.

  • palliative care
  • clinical protocols
  • healthcare quality improvement
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjoq-2020-001003

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    Footnotes

    • Contributors PS and RT planned and developed the idea for the quality improvement project. PS conducted the literature search, undertook some of the data collection, undertook the statistical analysis, and produced the manuscript. AT undertook a significant part of the data collection and also aided with statistical analysis. RT supervised the project and aided with review of the manuscript and performed liason with our pharmacy colleagues.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article.