Protocol for assessing the impact of the 6thNational Audit Project recommendations on practice

1. Patient safety has been a growing area of concern, especially within perioperative care where risks of major complications during surgery exist. Anaphylaxis in the operating theatre is a life-threatening drug reaction that happens suddenly, without warning and can affect anyone. The 6th National Audit Project (NAP6) of the Royal College of Anaesthetists (RCoA): Perioperative Anaphylaxis was the largest ever prospective study of anaphylaxis related to anaesthesia and surgery. The findings from the audit were collated into a report and included recommendations for improved patient care. The purpose of this study is to understand the perceptions of the NAP6 recommendations and their impact on practice. This study will use ethnographic qualitative methods in the form of observations, interviews and a documentary analysis. The sessions targeted for observations will include departmental or hospital meetings, and educational or training sessions, related to perioperative anaphylaxis. The target sample size of 78 healthcare professionals across six hospitals within England, will include individuals with roles specific to anaesthesia, surgery, immunology, allergy and governance. Additionally, six stakeholders will be interviewed who can provide insights into the NAP6 recommendations at the national level. Across the six sites, local collaborators will share any relevant documents related to perioperative anaphylaxis or the NAP-6 recommendations. The study has received regulatory approvals from the Health Research Authority and has been funded by the National Institute for Health and Care Research.