Safety in anaesthesia

The Anaesthetist’s Task

Tarek Samir Shabana

Lecturer of Anaesthesia

Ain Shams University

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

“ It is not the drug that is dangerous, but the man who administers it is”

Sir Robert Macintosh

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

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

Human factor limitations

Fatigue, stressSurrounding atmosphere Increasingly complex systemsLack of communication

The Swiss Cheese Model

Pre-Use Preparation and Checkout of Equipment

• Infusions • Syringe labelling• Life support equipment• Anaesthesia machine and ventilator

The FDA Recommendations for Anesthesia Apparatus Checkout

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

The FDA Recommendations for Anesthesia Apparatus Checkout

4. Perform leak check (universal negative pressure leak test)

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

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

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).

.

Patient Identification

Use at least two identifiers (e.g. name

and date of birth) , neither of them should be the patient’s room number

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)

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

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

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.

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.

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)

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

3. All institutions providing sedation to patients must comply with anaesthesiology recognised sedation standards for safe practice.

4. All institutions should support the WHO Safe Surgery Saves Lives initiative and

Checklist

. 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

Shifting to a safety culture

Learning culture

Just Culture

Open (blame-free) culture

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

TAKE HOME MESSAGE

1.Continuous Training, education and assesment

2. Protocols (preoperative, intraoperative, postoperative)

3.Comply with standards of anaesthesia care

4. Incident reporting

THANK YOU