PATIENT SAFETY AND QUALITY ASSURANCE IN ANESTHESIA

Abstract

Anesthesiology is a high-risk specialty as compared with other specialties in medicine becauseAnesthesia may contribute to death in about 1 per 10,000 anesthetics. Many other patientsmay suffer serious and costly nonfatal injuries such as permanent neurologic damage (paraplegia and vegetative). Since, Anesthetists are responsible for patient safety during operations; therefore it is crucial to know the factors threatening patient safety in the operation room and search for strategies to deal with them. Factors threatening patient safety in the operation rooms and are causes for accidents (where there is rarely a single cause). EquipmentCauses: • Design flaw • User error • Malfunction Strategies to prevent:pre-use checkout • Check of aesthetic machine • Oxygen supply • A backup O2 tank • Never shut down audible alarms (very important) • Emergency ventilation equipment PatientCauses: • Underlying diseases: hyperthyroidism-thyroid storm, hyperosmolarcoma, Diabetes ketoacidosis. • Allergic reaction to some drug. Strategies toprevent:Preoperative evaluations Anaesthetist and Surgeons “Human error “ • Human factors affecting performance such as:fatigue, noise, boredom, long hours, hunger, tension • Deviations from accepted anaesthesia practices. • A lapse in vigilance and no attention to detail. Strategies to Prevent “Human error “ • Vigilance and attention to detail are essential for a safely conducted aesthetic. Since Vigilance lets anaesthetists find abnormal signs as early as possible as well as allows the anaesthetist to remain aware of the surrounding events and signals while performing other tasks. • Follow protocols for facilitation of process and aid in missing out on an essential element. General safety strategies 1) Pre-operative plan:- • Preoperative visit to the patient to let us know the patient’s condition in detail,Make an anaesthesia plan to let us know clearly how to perform the anaesthesia and how to deal with possible crisis, • Check anaesthesiamachine, monitors and other devices,Prepare the workspace to make us work more conveniently and efficiently. Arrange equipment and appropriate monitors in a way that facilitates this. So we can clearly observe the patient and easily manipulate all devices. • Check backup equipment; know the location of emergency supplies and equipment. • Label all medications. 2)Develop situational awareness(Intra-operative) • Use a systematic approach to scanning the machine, monitors, patient, surgical field, and surroundings • If one vital sign is anomalous, quickly assess the others while repeating the measurement and observing what is happening on the surgical field. 3) Verify observations • Cross-check observations • Assess covarying variables • Review it with a second person. 4)Implement compensatory responses • If something wrong happens urgently, first implementing time-buyingmeasures.e.g., increase the fraction of inspired oxygen when oxygen saturation falls; administer intravenous fluids or vasopressors when hypotension occurs). Then search out any correctable primary cause and treat it appropriately 5) Prepare for crisis • If there is any critical events happened (cardiac arrest, malignant hyperthermia or difficult intubation), call for help early (WHY), then use accepted protocols for emergencies and resuscitation (e.g., advanced cardiac life support, malignant hyperthermia protocols). 6) Enhance teamwork; communicate • To enhance teamwork and communication, address surgeons and nurses early in the case by knowing names. Make requests and delegate tasks clearly and specifically by name (e.g., “Jack, do task X and tell me when task X is completed.”). 7) Compensate for stressors • Anaesthetist is a stressful job. If you feel very tired, ask for a relief. • Reduce various stressors: noise, fatigue, interpersonal tension, etc. optimize the work environment. 8) Recognize and address production pressures • Patient safety must remain the highest priority • In big hospitals, anaesthetists have a great deal of workload. There are many operations every day. Anytime we can’t sacrifice patient safety in order to emphasize production. If there is no adequate preoperative evaluation, preparation, or monitoring, it is unsafe to anesthetize the patient. You must address concerns explicitly to surgeons and cancel the operation 9)Learn from close calls • Every mistake is an opportunity to learn and improve. • Analysis and feedback of adverse eventsto identify and assess system problems