Improving documentation of endotracheal intubation in an adult emergency department

To evaluate the effect of an educational intervention and documentary pro forma on the adequacy of documentation of intubation in an adult ED.

A structured medical record review was performed before and after a multi-pronged educational programme and introduction of a specifically designed guide to documentation. Records were assessed for adequacy of documentation by the presence or absence of predetermined elements. Analysis focused on five aspects considered to be most important for future clinical care: drugs and doses used, grade of view, size of endotracheal tube, confirmation of placement and adverse events/difficulties encountered.

Sixty-one and sixty-eight charts were included in the pre-intervention and post-intervention groups, respectively. The drugs and doses used were documented in 92% and 93%. The endotracheal tube size was recorded 82% and 91% of the time. Grade of laryngoscopy was documented in 35% and 46%. Confirmation of endotracheal tube placement was 69% and 84%. Presence or absence of adverse events was recorded in 37% and 54%. All five elements were present in 8.2% and 25% of medical records.

Documentation improved slightly following the intervention, but was still unsatisfactory. We believe that to achieve an adequate level of documentation in the medical record for an episode of intubation, there needs to be a formal and structured mechanism, either via mandatory use of a specifically designed form and/or by participation in an organized data registry.