Safety in Anaesthesia : the anaesthetist's task
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Transcript of Safety in Anaesthesia : the anaesthetist's task
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Safety in anaesthesia
The Anaesthetist’s Task
Tarek Samir Shabana
Lecturer of Anaesthesia
Ain Shams University
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Objectives :
Understanding the importance of human factors in anaesthesia practice
Identifying limitations of human factor Introducing the principles of the Helsinki declaration for
patient safety
Understanding the value of incident reporting in creating a patient safe culture
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“ It is not the drug that is dangerous, but the man who administers it is”
Sir Robert Macintosh
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Human factor defined
The performance of a person working within a
complex mechanical system
Performance is dependant on the individual’s capabilities,
limitations and attitudes
Peformance is also directly related to the quality of
instructions and training provided
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Human factor
I. Technical skills
such as intubation or central venous access, are taught and assessed
II. Non-technical skills
Including situational awareness, decision-making, leader ship, teamwork and communication
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Human factor limitations
Fatigue, stressSurrounding atmosphere Increasingly complex systemsLack of communication
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The Swiss Cheese Model
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Pre-Use Preparation and Checkout of Equipment
• Infusions • Syringe labelling• Life support equipment• Anaesthesia machine and ventilator
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The FDA Recommendations for Anesthesia Apparatus Checkout
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The FDA Recommendations for Anesthesia Apparatus Checkout
1. Emergency ventilation equipment
2. High pressure system• cylinder half-filled ( 1000 psi)• central pipeline supply hoses connected, gauge
reading 50 psi
3. Low pressure systemCheck initial status : turn vaporizer off, check level and tighten cap
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The FDA Recommendations for Anesthesia Apparatus Checkout
4. Perform leak check (universal negative pressure leak test)
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The FDA Recommendations for Anesthesia Apparatus Checkout
5. Turn master switch on
6. Flowmeters (full range, hypoxic guard)
7. Scavenging system
8. Calibrate O2 sensors Expose to room air and allow to equilibrate (2 min). Then expose to oxygen source and ensure it reads near 100%
9. Check breathing system
10. Perform leak check for breathing system
Minimal gas flow close APL occlude Y piece O2 flush till 30 cmH2O ensure pressure fixed for 10 sec
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The FDA Recommendations for Anesthesia Apparatus Checkout
11. Check ventilation systems and unidirectional valves
12.Check, calibrate, set alarm limits of all monitors
13.Final status of machine: Vaporizers off Bag/Vent switch to "bag" mode APL open Zero flows on flowmeters Suction adequate Breathing system ready
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Syringe labelling
Medication errors are the second most common category of incident reported to the NPSACousins D, Gerrett D, Warner B. A review of medication incidents reported to the National Reporting and Learning System in England over six years (2005–2010).
.
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Patient Identification
Use at least two identifiers (e.g. name
and date of birth) , neither of them should be the patient’s room number
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ASA standards for basic anaesthetic monitoring
I. Qualified provider throughout anaesthesia
II. Oxygenation : O2 analyser / oximeter
III. Ventilation : Capnography / ventilator alarms
IV. Circulation : ECG /BP
V. Temperature
+ Observe ( colour/ chest movement/ blood loss)
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Anaesthetic record
. The anesthetist must keep a good record of the course of anesthetic; otherwise it will be difficult to defend a case should things go wrong
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Postoperative
AAGBI safety guidelines 2013
PACU after general, spinal or epidural
Monitored / observed (1:1)
Trained nurse
Discharged only by anaesthesiologist
Written criteria for discharge
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The Helsinki declaration for patient safety in anaesthesiology
Prepared jointly by The European Board of Anaesthesiology (EBA) and the European Society of Anaesthesiology (ESA). It was launched in June 2010 at the Euroanaesthesia meeting in
Helsinki.
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1. All institutions providing perioperative anaesthesia care to patients should comply with the minimum standards of monitoring recommended by the EBA both in operating theatres and in recovery areas.
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1. Pulse oximeter
2. NIBP
3. ECG
4. Temperature
5. Airway gases (CO2, O2, vapor)
6. Airway pressure
7. Nerve stimulator ( if muscle relaxants are used)
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2. All such institutions should have protocols and the necessary facilities for managing the following :A.Preoperative assessment and preparation
B.Conduct of anaesthesia • Checking Equipment and drugs• Syringe labelling• Difficult/failed intubation• Malignant hyperpyrexia• Anaphylaxis• Local anaesthetic toxicity• Massive haemorrhage• Infection control
C.Postoperative care including pain relief
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3. All institutions providing sedation to patients must comply with anaesthesiology recognised sedation standards for safe practice.
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4. All institutions should support the WHO Safe Surgery Saves Lives initiative and
Checklist
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. 5.All departments of anaesthesiology in Europe must be able to produce an annual report of measures taken and results obtained in improving patient safety locally.
6. All institutions providing anaesthesiological care to patients must collect the required data to be able to produce an annual report on patient morbidity and mortality.
7. All institutions providing anaesthesiological care to patients must contribute to the recognised national or other major audits of safe practice and critical incident reporting systems. Resources must be provided to achieve this
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Shifting to a safety culture
Learning culture
Just Culture
Open (blame-free) culture
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The closed claim project(University of washington, seattle)
In depth investigation of closed insurance claims
database
Case summarized by volunteer
anaesthesiologist
Prevention and patient
sfety
Identify major areas of loss
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TAKE HOME MESSAGE
1.Continuous Training, education and assesment
2. Protocols (preoperative, intraoperative, postoperative)
3.Comply with standards of anaesthesia care
4. Incident reporting
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THANK YOU