Implementing NAP4

The NAP4 report included more than 160 recommendations. These were designed to make airway management during anaesthesia, in intensive care and in emergency departments safer.

It is hoped that many departments will have implemented these recommendations in full already. However, others may have found some difficulty with some recommendations. This page offers resources to try and help those departments.

Airway Leads

The RCoA and DAS announced that all Departments of Anaesthesia are "strongly recommended" to have a named RCoA/DAS Departmental Airway Lead. Implementation of NAP4 recommendations was one of the main aims of the creation of this role.

If your hospital does not have a nominated Airway Lead, please contact your Clinical Director and ask that they nominate one.


Following NAP4, the President of the Royal College of Anaesthetists wrote to all Trust CEOs reinforcing several recommendations, including that all patients ventilated in theatre, the ICU or ED should be monitored with continuous capnography.

Since then, the Association of Anaesthetists of Great Britain and Ireland's Capnography Outside the Operating Theatre guidelines, the Intensive Care Society's Capnograpy Guidelines, and the European Board of Anesthesiology Capnography Recommendations have all been revised or issued.

As a consequence of these changes, to not have continuous capnography on your ICU or in your ED now goes against all mainstream recommendations.

Implementing NAP4 Presentation

This presentation gives an insight into how some of the more challenging recommendations have been approached and implemented in the Royal United Hospital, Bath.

We are grateful to Dr Fiona Kelly, Consultant Anaesthetist in Bath, for allowing us to use this presentation.

We hope that those departments that have not yet implemented the NAP4 recommendations will now be able to.