The United Kingdom National Audit Projects: a narrative review

Abstract

The Royal College of Anaesthetists' National Audit Project (NAP) programme has been running in its current form since 2006. Since NAP3 was commissioned the NAPs have examined rare but important complications of anaesthesia and related subspecialties. The topics covered include major complications of central neuraxial block (NAP3), major complications of airway management in hospitals (NAP4) and accidental awareness during general anaesthesia (NAP5). NAP6 is currently studying severe perioperative anaphylaxis. The NAPs have shed new light on the major complications of anaesthesia, providing both quantitative (frequencies, prevalence, incidence, risk factors) and qualitative (themes, patient stories, human factors) knowledge that has led to new learning, recommendations and changes in practice. This article describes the background, nature and processes of the NAPs.

UK anaesthetists’ perspectives and experiences of severe perioperative anaphylaxis: NAP6 baseline survey

“…The National Audit Projects are a series of service evaluations examining major complications related to anaesthesia, run by the Royal College of Anaesthetists (RCoA). 7 The Sixth National Audit Project (NAP6) is designed to prospectively examine quantitative and qualitative aspects of severe perioperative anaphylaxis. NAP6 comprises four components: a baseline survey of anaesthetists; a survey of specialist allergy clinics; a year-long, anonymized case-reporting phase; and lastly a survey of anaesthetic activity and exposure to potential perioperative allergens.…”

Auditing the national audit projects: impact and implementation

“…5e10 An important feature of the NAPs has been the extensive engagement of anaesthetists throughout the UK (and Ireland in the case of NAP5), and the promotion of multidisciplinary and crossorganisational collaborations. 11 Towards the end of the last millennium, a strong emphasis emerged in the UK on the conduct of clinical audit projects in medical practice. This focus on audit was occurring concurrently with major structural changes in medical training programs, under the banner of Calman and other reforms.…”

“…For the last four NAPs, three general processes were conducted. 11 First, a baseline national survey was sent to all anaesthetists in the UK to establish practices and knowledge. This step had an important benchmarking role.…”

“…These recommendations have typically been targeted at individual clinicians, at departments, at hospitals or trusts, and at national bodies and organisations. 11 In this issue of the British Journal of Anaesthesia, based on the activity survey of NAP6, Kemp and colleagues 6 report on key features of anaesthetic workload and practices throughout the UK in 2016. Reassuringly, the majority of all cases (88.7%) were under the direct care of a consultant or career grade anaesthetist, with a modest reduction on Saturday (80.5%) and Sunday (65.9%).…”

Measuring the clinical impact of National Audit Projects

“…It remains an important challenge for the NAP programme to identify whether these projects have led to demonstrable change in practice, and more importantly improvements in patient safety . A survey in 2011 identified that within a year of publication of NAP3, half of hospitals had changed information provided to patients and one quarter had changed clinical practices .…”