An ethnographic study of the impact on clinical practice of the Royal College of Anaesthetists' 6th National Audit Project recommendations (on the investigation, prevention and management of perioperative anaphylaxis)

Patient safety within perioperative care is significant due to the potential for major complications requiring a rapid response. The Royal College of Anaesthetists’ National Audit Projects (NAPs) have sought to improve patient safety by investigating serious and rare complications occurring during anaesthesia. The sixth NAP (NAP6), focused on perioperative anaphylaxis, and produced 134 recommendations. Staff perceptions of the impact of NAP6 recommendations have not been studied, which was the purpose of this research.

Semi-structured interviews were conducted with a purposive sample of 21 healthcare professionals across three teaching hospitals in England and with five stakeholders who could share a national perspective. A documentary analysis was conducted with departmental and institutional documents associated with the training for, and management of perioperative anaphylaxis.

Examples of perceived impact included: raised awareness on the main culprits of perioperative anaphylaxis, and awareness to consider an event as anaphylaxis; changes in referrals of patients to allergy clinics; increased penicillin de-labelling initiatives; better communication with healthcare professionals and patients; alerts to remind staff on recommended care; and updates to national guidelines. Limited access to allergy clinics; the need for further penicillin de-labelling; the lack of accountability for implementing recommendations; misalignment between disciplines; difficulties removing incorrect allergy labels; and limited dissemination were highlighted as areas for improvement in implementation. Whilst access to allergy clinics; good relationships with stakeholders in the field; hospitals engaged with quality improvement initiatives; and the perioperative allergy network were recognised as enablers to implementation.

Future areas for consideration based on the perspectives shared by interviewees include improving access to allergy testing, enhancing penicillin de-labelling initiatives, and sharing guidance on how to implement the recommendations (including funding).

Lead Investigator