This study analyzed equipment-related problems that occurred during 83,154 anesthetics over 5 years at a university hospital in Norway. The researchers found that the frequency of equipment problems was low, occurring in 0.05% of regional anesthetics and 0.23% of general anesthetics. One-third of problems involved the anesthesia machine. In a quarter of cases, human error contributed to the problem. No patients died or suffered lasting harm from equipment problems. The researchers concluded that the rate of equipment issues was low and mostly minor in severity. Aside from improving equipment check procedures, no new strategies were needed to reduce problems further.
The document discusses the surgical team and perioperative nursing. It describes:
1) The major types of pathologic processes requiring surgery such as obstruction, perforation, erosion, and tumors.
2) The classification of surgical procedures according to purpose such as diagnostic, exploratory, curative, and palliative, and according to urgency such as emergent, urgent, elective, and non-urgent.
3) The roles of the surgical team which includes the surgeon, assistant surgeon, anesthesiologist, scrub nurse, and circulating nurse. The roles and responsibilities of each member are outlined.
1) The document discusses perioperative nursing, including types of surgical procedures, classifications of procedures, informed consent, preoperative medications and teachings, and the surgical team.
2) It also discusses postoperative complications involving various body systems like respiratory, circulatory, and wounds. Principles of surgical asepsis and PACU/RR care are outlined.
3) Oncology nursing is discussed, differentiating benign and malignant neoplasms. Recommendations for cancer screening and warning signs of cancer are provided. Internal radiation therapy and nursing management are summarized.
This document provides an overview of two studies being presented at an LDI symposium. The first study analyzes video recordings of clinician interactions with patients, nurses and families in the surgical intensive care unit. It aims to evaluate the extent of clinician involvement and how it may impact outcomes. The second study seeks to identify characteristics of effective ad hoc trauma resuscitation teams and how team functioning affects patient outcomes. It will survey team members and analyze responses to identify qualities of high performing teams with the goal of developing training to improve collaboration and outcomes.
Bundle care for Hospital Accord Infection.GODWIN SUJIN
This document outlines 5 care bundles:
1. Central line bundle to reduce central line-associated bloodstream infections.
2. Pressure ulcer prevention bundle to reduce decubitus ulcers.
3. Surgical site infection bundle to reduce surgical site infections.
4. Urinary tract infection bundle to reduce UTIs.
5. Ventilator-associated pneumonia bundle to reduce VAP.
Each bundle consists of evidence-based interventions that, when implemented together, significantly improve patient outcomes more than any single intervention alone. The focus is on completing the entire bundle rather than individual components.
This retrospective analysis examined 509 patients who received interscalene catheters for ambulatory shoulder surgery. Adverse events occurred in 34 patients (6.7%), most commonly catheter dislocation diagnosed in the recovery room or at home with pain. Twelve patients (2.4%) were re-admitted to the hospital, most commonly for pain. The study found that with appropriate patient selection, trained staff, and protocols for managing adverse events, interscalene catheters can be safely used to provide analgesia for ambulatory shoulder surgery.
This document discusses perioperative nursing. It covers the three phases of perioperative care: preoperative, intraoperative, and postoperative. It describes goals and assessments for the preoperative phase, including physiologic and psychologic evaluation of the patient and providing education. Surgical procedures are classified based on purpose, urgency, degree of risk, and whether they are performed as ambulatory/same-day surgery. Risks and the patient's fears and concerns are addressed. Informed consent is also discussed.
Apply Patient Safety Solutions to Clinical Practice: why is it so hard by S. ...ALIAS Network
The document summarizes a presentation given by Sara Albolino and Riccardo Tartaglia on applying patient safety solutions in clinical practice. The presentation covered:
1) Barriers to improving patient safety in healthcare, including differences from other high-risk industries and emotional involvement of clinicians.
2) Studies showing the incidence of adverse events is around 9% globally but improving slowly despite efforts.
3) Interventions need to consider the healthcare context and developing a safety culture is important to improving reliability.
4) A systems approach is necessary to address patient safety, not just individual practices or technologies. Standardization and measuring outcomes is important going forward.
The document provides an overview of perioperative nursing care. It discusses the three phases of surgery: preoperative, intraoperative, and postoperative. In the preoperative phase, the nurse conducts assessments, provides education to the client, and ensures informed consent is obtained. During surgery, nurses manage risks and ensure proper technique is maintained. In post-op, nurses monitor for complications and promote recovery. Perioperative nursing aims to provide excellent care before, during, and after surgery by addressing clients' physical and psychosocial needs.
The document discusses the surgical team and perioperative nursing. It describes:
1) The major types of pathologic processes requiring surgery such as obstruction, perforation, erosion, and tumors.
2) The classification of surgical procedures according to purpose such as diagnostic, exploratory, curative, and palliative, and according to urgency such as emergent, urgent, elective, and non-urgent.
3) The roles of the surgical team which includes the surgeon, assistant surgeon, anesthesiologist, scrub nurse, and circulating nurse. The roles and responsibilities of each member are outlined.
1) The document discusses perioperative nursing, including types of surgical procedures, classifications of procedures, informed consent, preoperative medications and teachings, and the surgical team.
2) It also discusses postoperative complications involving various body systems like respiratory, circulatory, and wounds. Principles of surgical asepsis and PACU/RR care are outlined.
3) Oncology nursing is discussed, differentiating benign and malignant neoplasms. Recommendations for cancer screening and warning signs of cancer are provided. Internal radiation therapy and nursing management are summarized.
This document provides an overview of two studies being presented at an LDI symposium. The first study analyzes video recordings of clinician interactions with patients, nurses and families in the surgical intensive care unit. It aims to evaluate the extent of clinician involvement and how it may impact outcomes. The second study seeks to identify characteristics of effective ad hoc trauma resuscitation teams and how team functioning affects patient outcomes. It will survey team members and analyze responses to identify qualities of high performing teams with the goal of developing training to improve collaboration and outcomes.
Bundle care for Hospital Accord Infection.GODWIN SUJIN
This document outlines 5 care bundles:
1. Central line bundle to reduce central line-associated bloodstream infections.
2. Pressure ulcer prevention bundle to reduce decubitus ulcers.
3. Surgical site infection bundle to reduce surgical site infections.
4. Urinary tract infection bundle to reduce UTIs.
5. Ventilator-associated pneumonia bundle to reduce VAP.
Each bundle consists of evidence-based interventions that, when implemented together, significantly improve patient outcomes more than any single intervention alone. The focus is on completing the entire bundle rather than individual components.
This retrospective analysis examined 509 patients who received interscalene catheters for ambulatory shoulder surgery. Adverse events occurred in 34 patients (6.7%), most commonly catheter dislocation diagnosed in the recovery room or at home with pain. Twelve patients (2.4%) were re-admitted to the hospital, most commonly for pain. The study found that with appropriate patient selection, trained staff, and protocols for managing adverse events, interscalene catheters can be safely used to provide analgesia for ambulatory shoulder surgery.
This document discusses perioperative nursing. It covers the three phases of perioperative care: preoperative, intraoperative, and postoperative. It describes goals and assessments for the preoperative phase, including physiologic and psychologic evaluation of the patient and providing education. Surgical procedures are classified based on purpose, urgency, degree of risk, and whether they are performed as ambulatory/same-day surgery. Risks and the patient's fears and concerns are addressed. Informed consent is also discussed.
Apply Patient Safety Solutions to Clinical Practice: why is it so hard by S. ...ALIAS Network
The document summarizes a presentation given by Sara Albolino and Riccardo Tartaglia on applying patient safety solutions in clinical practice. The presentation covered:
1) Barriers to improving patient safety in healthcare, including differences from other high-risk industries and emotional involvement of clinicians.
2) Studies showing the incidence of adverse events is around 9% globally but improving slowly despite efforts.
3) Interventions need to consider the healthcare context and developing a safety culture is important to improving reliability.
4) A systems approach is necessary to address patient safety, not just individual practices or technologies. Standardization and measuring outcomes is important going forward.
The document provides an overview of perioperative nursing care. It discusses the three phases of surgery: preoperative, intraoperative, and postoperative. In the preoperative phase, the nurse conducts assessments, provides education to the client, and ensures informed consent is obtained. During surgery, nurses manage risks and ensure proper technique is maintained. In post-op, nurses monitor for complications and promote recovery. Perioperative nursing aims to provide excellent care before, during, and after surgery by addressing clients' physical and psychosocial needs.
Anesthetic risk, quality improvement and liability●๋•αηкιтα madan
This document discusses anesthesia risk and mortality. It provides estimates from various studies that anesthesia-related mortality rates range from less than 1 per 10,000 anesthetics to 1 per 1,560 anesthetics historically. Common complications discussed include nerve injuries, awareness during general anesthesia, eye/dental injuries, and postoperative cognitive dysfunction in elderly patients. Risk management strategies to minimize liability like adherence to standards of care, vigilance, documentation, and informed consent are also outlined.
Francis Derk1, Troy Wilde2,
Tim Pham2, Mike Griffiths3
1South Texas VA Medical Center (San Antonio, United States)
2UTHSC (San Antonio, United States)
3AOTI (Oceanside, United States)
EWMA 2013 - Ep534 - Prevention of pressure ulcers in cardiac surgery patientsEWMAConference
The document discusses prevention of pressure ulcers in cardiac surgery patients. It conducted a study using soft silicone dressings placed before surgery to preserve skin integrity in high-risk patients. Of the 26 patients monitored, 9 were high risk. For the high risk patients in the first post-operative period, 70% could not move and 100% had decreased hemoglobin, risk factors for pressure ulcers. Using the soft silicone dressings, the high risk patients did not develop any pressure ulcers and found the dressings comfortable. The study concludes the dressings were an effective prevention measure but more needs to be done to increase pressure ulcer prevention care.
The document discusses peri-operative nursing care. It defines the peri-operative period as including pre-operative, intra-operative, and post-operative phases, with the goal of providing better care for patients before, during, and after surgery. The document outlines the nursing assessments and goals in the pre-operative phase including physiological assessments, informed consent, diagnostic tests, and nursing diagnoses. It also discusses post-operative nursing care focusing on airway, breathing, circulation, and other factors.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
This study evaluated patient controlled sedation (PCS) using propofol and alfentanil for dressing changes in 11 burn patients with over 10% total burn surface area. PCS was compared to sedation provided by an anesthesiologist. Patients preferred PCS due to greater control and less discomfort during recovery. No adverse respiratory or cardiovascular events occurred with PCS. Procedural pain was higher with PCS but lower after the procedure. The study concluded that PCS is an effective and safe alternative to anesthesiologist-provided sedation for burn dressing changes, but noted the small sample size limited the strength of this conclusion and further studies are warranted.
Discover how a large healthcare provider was able to decrease lost anesthesia drug charges by 40% and improve patient safety through improved Anesthesia management
Best practices in preventing retained foreign objectsMhmarlin
1) The document describes four case studies related to retained surgical items and issues with surgical counting practices. In the first case study, distraction was identified as the primary cause of a retained sponge during a vaginal repair surgery involving multiple observers.
2) The second case study describes an incident where the circulating nurse documented adding sponges to the field before actually doing so, becoming distracted, and failing to deliver the second pack of sponges, resulting in a missing count.
3) The third case study discusses the increasing reports of retained incisional sponges used during endoscopic saphenous vein harvesting procedures despite their small size.
The document summarizes the activities of the Rotary Club of Makati Greenbelt. It discusses upcoming events like a raffle draw and medical mission. It also recaps a recent fundraiser event at the Manila Polo Club that the club supported. An officer profile is provided for PP Alfredo "Al" Joaquin who has long been involved with the club. The newsletter closes with reminders about upcoming activities in October through December, including a tree planting event, Christmas feeding project, and fellowship gathering.
This editorial discusses the potential long-term consequences of anesthetic management that extend beyond the immediate perioperative period. It notes that while preventable anesthetic mortality has declined greatly, all-cause postoperative mortality remains high at around 5-10%. The editorial then examines evidence that some intraoperative decisions can influence long-term outcomes like surgical site infections, cancer recurrence, and cardiovascular events. Specifically, it discusses how hypothermia increases infection risk, and how regional anesthesia may help preserve the immune system and reduce cancer metastasis. The editorial concludes by highlighting several other recent editorials in Anesthesiology that also explored long-term outcomes.
Madagascar. Scalin up micro-irrigation. Andriamanalina Raharinjatovo Fenomanantsoa, Project coordinator, Agriculturalists and Veterinaries without Frontiers. Furthering water cooperation in rural areas. Making it happen! International Annual UN-Water Zaragoza Conference 2012/2013. Preparing for the 2013 International Year. Water Cooperation: Making it Happen! 8-10 January 2013
The document provides information about Rotary Club Makati Greenbelt's activities in October 2009. It discusses the club hosting the 3rd leg of the Governor's Cup golf tournament. It also describes the club distributing relief goods to areas affected by typhoons. Additionally, it announces upcoming club meetings and events, such as a medical-dental mission, tree planting, and Christmas activities. The newsletter aims to keep members informed and engaged in service.
Definitive Consulting is an executive search firm that provides clients in professional services sectors with exclusive access to top talent. The firm focuses on building long-term relationships and takes a strategic advisory approach to identifying candidates that are the best fit for both the client's needs and the individual's career goals. Definitive Consulting aims to deliver competitive advantage for its clients through its niche market expertise and targeted recruitment approach.
The document summarizes Rotary's objectives and provides updates from the Rotary Club of Makati Greenbelt. It discusses Rotary's goal of encouraging fellowship, high ethical standards, and international understanding. It also describes the club's relief efforts after Typhoon Ondoy, including donating supplies and distributing them in Taguig. The club co-hosted a district conference and participated in medical missions with a sister club.
The document summarizes the implementation of a crew resource management (CRM) training program at York Hospital to improve communication and teamwork in operating rooms (ORs) and enhance patient safety. The hospital developed a four-module CRM curriculum taught to over 530 OR staff members over two years. Observational studies found briefings and debriefings increased from 67% and 42% utilization before training to 100% and 87% utilization after training, suggesting improved adoption of CRM techniques. While no formal statistical analysis was conducted, patient safety culture survey scores improved slightly after implementation. The program demonstrated that a community hospital can successfully develop and adopt a customized CRM program to foster a culture of safety.
A Context-aware Patient Safety System for the Operating RoomJakob Bardram
This is the presentation of the paper entitled "A Context-aware Patient Safety System for the Operating Room" by Jakob E. Bardram and Niels Nørskov. Presented at UbiComp September 2008 in Seoul, Korea.
Setting up a Neurointervention cath labNeurologyKota
The document discusses guidelines for setting up a new neurointervention cath lab. It covers necessary physical space, equipment, staffing, protocols, and inventory. The lab should be near imaging modalities like CT and have biplane angiography equipment. Staffing includes a medical director, neurointerventionalists, technicians, nurses and support as needed. Standard protocols are outlined for procedures, informed consent, monitoring and radiation safety. A variety of medical devices, medications and supplies must be maintained and inventoried.
Using data from hospital information systems to improve emergency department ...Agus Mutamakin
This document summarizes 5 quality improvement projects conducted by the authors using data from hospital information systems to improve emergency department care. The projects included:
1. Providing follow-up information on patients admitted from the ED to educate staff.
2. Improving laboratory turnaround times by providing daily reports highlighting outliers.
3. Measuring ED crowding using hourly census data and its correlation with walkout rates and diversion.
4. Studying the effect of different troponin cutoff levels on positive test results and patient outcomes.
5. Developing a system to track diagnostic failures and missed foreign bodies to reduce malpractice risk.
Gaudreault et al-2015-anesthesia_&_analgesiasamirsharshar
The study evaluated the reliability of current perception threshold (CPT) measurements for assessing sensory block in two investigations. In the first study, CPT measurements in healthy volunteers showed good within-day reliability but more variable between-day reliability. In the second study with patients receiving femoral nerve blocks, CPT values significantly increased after local anesthetic administration and paralleled the loss of cold sensation, suggesting CPT can characterize sensory onset of peripheral nerve blocks. The study supports using CPT in future regional anesthesia research.
This document discusses the role of nurse practitioners (NPs) in emergency departments. It notes that NPs have practiced in emergency settings for over 4 decades and currently care for 13% of emergency department patients. With growing physician shortages and more insured patients under healthcare reform, NPs are well-positioned to help meet increasing demand as part of new models of emergency care that emphasize rapid triage, exams and disposition. The document also outlines educational and certification requirements for emergency NP practice as well as factors involved in successfully integrating NPs into emergency departments.
Health care technicians work in specialized areas of the health care industry under the supervision of physicians and other health care professionals. They require focused training and education in areas like emergency medical services, radiology, psychiatry, and medical laboratory services. The document provides examples of roles for several types of health care technicians and outlines some of their key responsibilities and the services they provide.
Anesthetic risk, quality improvement and liability●๋•αηкιтα madan
This document discusses anesthesia risk and mortality. It provides estimates from various studies that anesthesia-related mortality rates range from less than 1 per 10,000 anesthetics to 1 per 1,560 anesthetics historically. Common complications discussed include nerve injuries, awareness during general anesthesia, eye/dental injuries, and postoperative cognitive dysfunction in elderly patients. Risk management strategies to minimize liability like adherence to standards of care, vigilance, documentation, and informed consent are also outlined.
Francis Derk1, Troy Wilde2,
Tim Pham2, Mike Griffiths3
1South Texas VA Medical Center (San Antonio, United States)
2UTHSC (San Antonio, United States)
3AOTI (Oceanside, United States)
EWMA 2013 - Ep534 - Prevention of pressure ulcers in cardiac surgery patientsEWMAConference
The document discusses prevention of pressure ulcers in cardiac surgery patients. It conducted a study using soft silicone dressings placed before surgery to preserve skin integrity in high-risk patients. Of the 26 patients monitored, 9 were high risk. For the high risk patients in the first post-operative period, 70% could not move and 100% had decreased hemoglobin, risk factors for pressure ulcers. Using the soft silicone dressings, the high risk patients did not develop any pressure ulcers and found the dressings comfortable. The study concludes the dressings were an effective prevention measure but more needs to be done to increase pressure ulcer prevention care.
The document discusses peri-operative nursing care. It defines the peri-operative period as including pre-operative, intra-operative, and post-operative phases, with the goal of providing better care for patients before, during, and after surgery. The document outlines the nursing assessments and goals in the pre-operative phase including physiological assessments, informed consent, diagnostic tests, and nursing diagnoses. It also discusses post-operative nursing care focusing on airway, breathing, circulation, and other factors.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
This study evaluated patient controlled sedation (PCS) using propofol and alfentanil for dressing changes in 11 burn patients with over 10% total burn surface area. PCS was compared to sedation provided by an anesthesiologist. Patients preferred PCS due to greater control and less discomfort during recovery. No adverse respiratory or cardiovascular events occurred with PCS. Procedural pain was higher with PCS but lower after the procedure. The study concluded that PCS is an effective and safe alternative to anesthesiologist-provided sedation for burn dressing changes, but noted the small sample size limited the strength of this conclusion and further studies are warranted.
Discover how a large healthcare provider was able to decrease lost anesthesia drug charges by 40% and improve patient safety through improved Anesthesia management
Best practices in preventing retained foreign objectsMhmarlin
1) The document describes four case studies related to retained surgical items and issues with surgical counting practices. In the first case study, distraction was identified as the primary cause of a retained sponge during a vaginal repair surgery involving multiple observers.
2) The second case study describes an incident where the circulating nurse documented adding sponges to the field before actually doing so, becoming distracted, and failing to deliver the second pack of sponges, resulting in a missing count.
3) The third case study discusses the increasing reports of retained incisional sponges used during endoscopic saphenous vein harvesting procedures despite their small size.
The document summarizes the activities of the Rotary Club of Makati Greenbelt. It discusses upcoming events like a raffle draw and medical mission. It also recaps a recent fundraiser event at the Manila Polo Club that the club supported. An officer profile is provided for PP Alfredo "Al" Joaquin who has long been involved with the club. The newsletter closes with reminders about upcoming activities in October through December, including a tree planting event, Christmas feeding project, and fellowship gathering.
This editorial discusses the potential long-term consequences of anesthetic management that extend beyond the immediate perioperative period. It notes that while preventable anesthetic mortality has declined greatly, all-cause postoperative mortality remains high at around 5-10%. The editorial then examines evidence that some intraoperative decisions can influence long-term outcomes like surgical site infections, cancer recurrence, and cardiovascular events. Specifically, it discusses how hypothermia increases infection risk, and how regional anesthesia may help preserve the immune system and reduce cancer metastasis. The editorial concludes by highlighting several other recent editorials in Anesthesiology that also explored long-term outcomes.
Madagascar. Scalin up micro-irrigation. Andriamanalina Raharinjatovo Fenomanantsoa, Project coordinator, Agriculturalists and Veterinaries without Frontiers. Furthering water cooperation in rural areas. Making it happen! International Annual UN-Water Zaragoza Conference 2012/2013. Preparing for the 2013 International Year. Water Cooperation: Making it Happen! 8-10 January 2013
The document provides information about Rotary Club Makati Greenbelt's activities in October 2009. It discusses the club hosting the 3rd leg of the Governor's Cup golf tournament. It also describes the club distributing relief goods to areas affected by typhoons. Additionally, it announces upcoming club meetings and events, such as a medical-dental mission, tree planting, and Christmas activities. The newsletter aims to keep members informed and engaged in service.
Definitive Consulting is an executive search firm that provides clients in professional services sectors with exclusive access to top talent. The firm focuses on building long-term relationships and takes a strategic advisory approach to identifying candidates that are the best fit for both the client's needs and the individual's career goals. Definitive Consulting aims to deliver competitive advantage for its clients through its niche market expertise and targeted recruitment approach.
The document summarizes Rotary's objectives and provides updates from the Rotary Club of Makati Greenbelt. It discusses Rotary's goal of encouraging fellowship, high ethical standards, and international understanding. It also describes the club's relief efforts after Typhoon Ondoy, including donating supplies and distributing them in Taguig. The club co-hosted a district conference and participated in medical missions with a sister club.
The document summarizes the implementation of a crew resource management (CRM) training program at York Hospital to improve communication and teamwork in operating rooms (ORs) and enhance patient safety. The hospital developed a four-module CRM curriculum taught to over 530 OR staff members over two years. Observational studies found briefings and debriefings increased from 67% and 42% utilization before training to 100% and 87% utilization after training, suggesting improved adoption of CRM techniques. While no formal statistical analysis was conducted, patient safety culture survey scores improved slightly after implementation. The program demonstrated that a community hospital can successfully develop and adopt a customized CRM program to foster a culture of safety.
A Context-aware Patient Safety System for the Operating RoomJakob Bardram
This is the presentation of the paper entitled "A Context-aware Patient Safety System for the Operating Room" by Jakob E. Bardram and Niels Nørskov. Presented at UbiComp September 2008 in Seoul, Korea.
Setting up a Neurointervention cath labNeurologyKota
The document discusses guidelines for setting up a new neurointervention cath lab. It covers necessary physical space, equipment, staffing, protocols, and inventory. The lab should be near imaging modalities like CT and have biplane angiography equipment. Staffing includes a medical director, neurointerventionalists, technicians, nurses and support as needed. Standard protocols are outlined for procedures, informed consent, monitoring and radiation safety. A variety of medical devices, medications and supplies must be maintained and inventoried.
Using data from hospital information systems to improve emergency department ...Agus Mutamakin
This document summarizes 5 quality improvement projects conducted by the authors using data from hospital information systems to improve emergency department care. The projects included:
1. Providing follow-up information on patients admitted from the ED to educate staff.
2. Improving laboratory turnaround times by providing daily reports highlighting outliers.
3. Measuring ED crowding using hourly census data and its correlation with walkout rates and diversion.
4. Studying the effect of different troponin cutoff levels on positive test results and patient outcomes.
5. Developing a system to track diagnostic failures and missed foreign bodies to reduce malpractice risk.
Gaudreault et al-2015-anesthesia_&_analgesiasamirsharshar
The study evaluated the reliability of current perception threshold (CPT) measurements for assessing sensory block in two investigations. In the first study, CPT measurements in healthy volunteers showed good within-day reliability but more variable between-day reliability. In the second study with patients receiving femoral nerve blocks, CPT values significantly increased after local anesthetic administration and paralleled the loss of cold sensation, suggesting CPT can characterize sensory onset of peripheral nerve blocks. The study supports using CPT in future regional anesthesia research.
This document discusses the role of nurse practitioners (NPs) in emergency departments. It notes that NPs have practiced in emergency settings for over 4 decades and currently care for 13% of emergency department patients. With growing physician shortages and more insured patients under healthcare reform, NPs are well-positioned to help meet increasing demand as part of new models of emergency care that emphasize rapid triage, exams and disposition. The document also outlines educational and certification requirements for emergency NP practice as well as factors involved in successfully integrating NPs into emergency departments.
Health care technicians work in specialized areas of the health care industry under the supervision of physicians and other health care professionals. They require focused training and education in areas like emergency medical services, radiology, psychiatry, and medical laboratory services. The document provides examples of roles for several types of health care technicians and outlines some of their key responsibilities and the services they provide.
Alarm fatigue, caused by excessive numbers of alarms, is a national problem and patient safety issue. A quality improvement project was conducted on a medical telemetry unit to reduce alarm fatigue through various interventions such as individualizing patient alarm parameters, educating nursing staff, and improving communication. These interventions led to a significant decrease in the number of telemetry alarms and increased compliance with proper alarm management.
This study analyzed data from over 31,000 orthopedic trauma surgery cases to determine if the time of day of surgery affected mortality and complication rates. The results showed that surgeries performed in the afternoon or at night had significantly higher mortality rates (1.1% in morning vs 2.4% at night) and general complication rates compared to morning surgeries. Higher rates of emergencies, injury severity, and surgeon fatigue after-hours may contribute to these outcomes. While no differences were found for intra- or post-operative complication rates based on surgery time, optimizing patient safety at all times, including surgeon self-awareness, is important.
A New Real Time Clinical Decision Support System Using Machine Learning for C...IRJET Journal
This document presents a new real-time clinical decision support system using machine learning for critical care units. The system aims to predict mean arterial pressure (MAP) status in real-time at the bedside without requiring an offline training phase. It uses a two-stage machine learning framework: Stage I uses hierarchical temporal memory and online learning to process data streams and make unsupervised predictions in real-time. Stage II is a long short-term memory classifier that predicts future MAP status based on Stage I predictions. The system is evaluated and found to outperform logistic regression models in terms of accuracy, recall, precision and area under the receiver operating characteristic curve.
1) The study analyzed 170 incidents of difficult or failed intubation reported in the first 4000 incidents in the webAIRS anaesthesia database. 2) Patient factors like age 40-59 years and BMI over 30 kg/m2 were associated with higher risk, while emergency cases and multiple intubation attempts were common. 3) Outcomes included oxygen desaturation in 40 cases and death in 3 cases, with 12% experiencing moderate harm and 3.5% severe harm from the airway incidents.
Anesthesiologists must ensure patient safety during operations as anesthesia carries risks. Factors threatening safety include equipment issues, patient health conditions, and human factors like fatigue. Strategies to improve safety include thorough preoperative evaluations and planning, situational awareness during procedures, cross-checking observations, preparing for emergencies, enhancing teamwork, and learning from adverse events. Common errors involve airway issues, medication errors, and procedure mistakes, which can be avoided through vigilance, training, and following standards and guidelines. Quality assurance aims to improve care and minimize risks through documentation, safety training, and protocols for monitoring, handoffs, and responding to adverse events.
11.[9 19]maintenance management of medical equipment in hospitalsAlexander Decker
The document discusses medical equipment failures and maintenance management in hospitals. It provides a case study of a patient who received burns during surgery due to a faulty lamp. It also discusses other cases of equipment malfunctions harming patients. The document reviews literature on equipment maintenance management and strategic management of healthcare technology. It describes a study methodology that interviewed biomedical technicians at hospitals. The results showed public hospitals were less effective than private hospitals in areas like equipment selection, procurement, installation and training. Improving maintenance management practices was recommended to enhance patient safety.
EMS Provider Compliance with Infection Control Recommendations Is Suboptimal ...larry_johnson
This study observed 423 emergency medical services (EMS) transports arriving at a large, urban emergency department to assess compliance with infection control recommendations. The researchers found that only 56.9% of EMS providers wore gloves upon arrival and only 27.8% were observed washing their hands. When opportunities arose to disinfect reusable equipment, compliance was observed just 31.6% of the time. The study concluded that EMS provider compliance with standard precautions and equipment disinfection guidelines is suboptimal and strategies are needed to improve adherence to internationally recognized infection control practices.
Intraoperative neurophysiological monitoring team's communiqué with anesthesia professionals.
Background and Aims: Intraoperative neurophysiological monitoring (IONM) is the standard of care during many spinal, vascular, and intracranial surgeries. High-quality perioperative care requires the communication and cooperation of several multidisciplinary teams. One of these multidisciplinary services is intraoperative neuromonitoring (IONM), while other teams represent anesthesia and surgery. Few studies have investigated the IONM team's objective communication with anesthesia providers. We conducted a retrospective review of IONM-related quality assurance data to identify how changes in the evoked potentials observed during the surgery were communicated within our IONM-anesthesia team and determined the resulting qualitative outcomes.
Material and Methods: Quality assurance records of 3,112 patients who underwent surgical procedures with IONM (from 2010 to 2015) were reviewed. We examined communications regarding perioperative evoked potential or electroencephalography (EEG) fluctuations that prompted neurophysiologists to alert/notify the anesthesia team to consider alteration of anesthetic depth/drug regimen or patient positioning and analyzed the outcomes of these interventions.
Results: Of the total of 1280 (41.13%) communications issued, there were 347 notifications and 11 alerts made by the neurophysiologist to the anesthesia team for various types of neuro/orthopedic surgeries. Prompt communication led to resolution of 90% of alerts and 80% of notifications after corrective measures were executed by the anesthesiologists. Notifications mainly related to limb malpositioning and extravasation of intravenous fluid.
Conclusion: Based on our institutions' protocol and algorithm for intervention during IONM-supported surgeries, our findings of resolution in alerts and notifications indicate that successful communications between the two teams could potentially lead to improved anesthetic care and patient safety.
This document summarizes the introduction and evaluation of a telemedicine system for plastic surgery referrals in the UK. [1] A store-and-forward telemedicine system was implemented to allow referring hospitals to send digital images of injuries along with referrals. [2] An evaluation of over 900 referrals found the system was used for 42% of cases and helped overcome initial resistance from clinicians. [3] A prospective study of nearly 1000 patients found telemedicine referrals were 10% more likely to be directly booked for day surgery and there was a decrease in patients that could not be accepted due to lack of capacity.
The document outlines objectives and definitions for a level II student peri-operative nursing course. It discusses scrubbing, gowning, gloving and arranging surgical equipment. Key points include defining peri-operative nursing phases and terms like asepsis and sterilization. It also describes the operating room setup, personnel roles like surgeons and circulators, and traffic patterns to maximize efficiency while maintaining sterility.
Presentation to class at University of Notre Dame who are creating website and materials in honor of Amanda Abbiehl. Amanda died of a PCA-related incident and would have been attending college if she was alive.
Anesthesia carries risks that can lead to patient death or injury. Several factors contribute to risks in the operating room including equipment issues, patient health factors, human performance errors, and system failures. Some key errors that can cause severe harm are airway issues, medication errors, and procedure mistakes. Maintaining vigilance, checklists, standards, training, and learning from adverse events can help improve safety. Thorough documentation and review of incidents is important for quality assurance.
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Equipament problems during anaesthesia - Are they a quality problem?
1. British Journal of Anaesthesia 89 (6): 825±31 (2002)
Equipment problems during anaesthesiaÐare they a quality
problem?
S. Fasting* and S. E. Gisvold
Department of Anaesthesia and Intensive Care, University Hospital of Trondheim, N-7006 Trondheim,
Norway
*Corresponding author. E-mail: sigurd.fasting@medisin.ntnu.no
Background. Anaesthesia equipment problems may contribute to anaesthetic morbidity and
mortality. The magnitude and pattern of these problems are not established. We wanted to
analyse the frequency, type and severity of equipment-related problems in our department, and
if additional efforts to improve safety were needed.
Methods. The study is based on a system in which anaesthesia-related data are recorded from
all anaesthetic cases on a routine basis. The data include intraoperative problems and their
Downloaded from http://bja.oxfordjournals.org by on August 2, 2010
severity. When a problem occurs, the anaesthetist responsible for the case writes a short
description of the event on the anaesthetic chart. From all recorded cases of general and
regional anaesthesia, we selected cases recorded with anaesthetic `equipment/technical
problems'. These charts were retrieved from departmental archives for analysis.
Results. From 83 154 anaesthetics, we found the frequency of anaesthetic equipment
problems to be 0.05% during regional anaesthesia, and 0.23% during general anaesthesia. One-
third of problems involved the anaesthesia machine, and in a quarter, human error was
involved. No patient died and none suffered any lasting morbidity.
Conclusion. The rate of equipment problems was low, and most often of low severity. Aside
from improvements in routines for preoperative equipment checks, no speci®c strategies for
problem reduction could be suggested. The incidence of equipment problems is not a good
quality indicator because of the low rate of occurrence. However, recorded equipment
problems may be useful for improving quality, by analysing causative factors, and suggesting
preventative strategies.
Br J Anaesth 2002; 89: 825±31
Keywords: anaesthesia; complications, equipment problems; quality improvement
Accepted for publication: July 30, 2002
Anaesthesia equipment is important for the safe conduct of type, and severity of equipment-related problems in relation
anaesthesia, but equipment malfunction may also contribute to our current procedures for the checking of equipment and
to morbidity and mortality.1±3 The anaesthesia machine current working routines. We questioned whether additional
has most often been involved in equipment-related efforts were needed to improve safety with respect to
morbidity,1 4±7 and this has led to extensive use of equipment issues. A secondary aim was to illustrate how a
preoperative checklists. Previous studies have shown that routine-based system for problem recording can simplify
the frequency of equipment problems has varied from 0.2 to this type of continuous quality improvement in a depart-
2.1%. However, study design, method of problem reporting, ment.
and problem classi®cation have varied. In addition, routines
for the preoperative checking of anaesthesia machines and
other equipment have not been speci®ed.4 5 8±11 In 1985, our Methods
department instituted a system for the recording of anaes- The study is based on departmental data recorded over a
thetic-related data.12 We have studied equipment problems 5-yr period (1996±2000) from 83 154 consecutive anaes-
recorded from 83 154 consecutive cases from 1996 to 2000. thetics. One part of our standard anaesthetic record is
The primary aim of our study was to analyse the frequency, devoted to speci®ed data ®elds that must be completed by
Ó The Board of Management and Trustees of the British Journal of Anaesthesia 2002
2. Fasting and Gisvold
About 16 500 anaesthetics are given in our hospital each
year, and most types of surgery are performed (Trondheim
University Hospital, 960 beds, annual admission rate 43 000
patients, in 1999). In Norway, as in the rest of Scandinavia,
the physician anaesthetist works in cooperation with a
quali®ed nurse anaesthetist who has 18 months postgraduate
education in anaesthesia. The doctor has the medical
responsibility. Each morning the nurses do an extensive
check of the anaesthesia machine according to departmental
procedures. This check includes medical gas supplies, ¯ow-
meters, oxygen failure protection, vaporizers, machine/
breathing system leakage, machine/breathing system func-
tion, ventilator, scavenging, suction and intubation equip-
ment. Between patients a simpler check is performed. One
nurse is working full-time to educate all staff on equipment
issues, and the department engages two engineers for
continuous maintenance and repair of equipment.
The charts recorded with anaesthetic `equipment/tech-
Downloaded from http://bja.oxfordjournals.org by on August 2, 2010
nical problem' were retrieved from our departmental
archives. They were sorted according to the type of
equipment involved and analysed by the authors according
to frequency, severity and contributory factors. We analysed
not only cases of `true equipment failure' where the
equipment failed to perform as speci®ed, but also equipment
problems where `human error', `failure to check', or some
form of failing `human±equipment' interface was the most
Fig 1 When a problem occurs, the anaesthetist writes a short description important factor. We did not include problems with surgical
of the problem on the anaesthetic chart, and marks the problem check-
box according to problem type and severity.
equipment or `technical' problems with anaesthetic or
surgical procedures.
For categorical data, we used a c2-test or Fisher's exact
the end of the case. The data ®elds on all anaesthesia charts test as appropriate. We used a `c2-test for trend' for testing
are checked for completeness and accuracy by a consultant trends in binomial proportions.13 P<0.05 was considered
anaesthetist (SF or SEG) before secretaries enter data into statistically signi®cant.
the database. A copy of the anaesthetic record is stored in
the department.
One of the data ®elds is a check-box for `intraoperative Results
problems' (Fig. 1), including a list of 22 common anaes-
We recorded 83 154 anaesthetics during 1996 to 2000. The
thetic problems, and a ®eld for the severity. One of the age and ASA-class of the patient and type of surgery are
problems is `equipment/technical problems'. The anaesthe- presented in Table 1.
tist responsible for the patient writes a short description of
the event and marks the check-box accordingly. If the case
was `uneventful', this also must be indicated. Other data Frequency of equipment problems (Table 2)
®elds relate to the patient, the operation, type of anaesthetic, We retrieved 198 charts in which `equipment/technical
and timing of events. problems' were recorded. Of these, 41 were not included in
An `intraoperative problem' is de®ned as `an event that the ®nal analysis, as 29 cases represented dif®culties with
requires one or more measures, either to prevent further the actual performance of anaesthetic or surgical pro-
complications, or to treat a situation that is currently or cedures, six records were entered incorrectly into the
potentially serious, and does not routinely occur during the database, two charts were missing from the archives, and
conduct of anaesthesia'. The problem is graded according to in four cases the contributory factors of the problems were
severity. Severity `Grade 1' is a trivial problem, `Grade 2' is not described. We reviewed the resulting 157 cases of
a moderately dif®cult problem, with some effect on the anaesthetic equipment problems (0.19% of all cases). These
patient, but of a low severity. `Grade 3' is a serious situation equipment problems represented 1.1% of all recorded
that either proves very dif®cult to handle or causes a serious problems (157/13 756). The occurrence of equipment
deterioration in the patient's state, which may or may not problems was higher during general anaesthesia than
contribute to postoperative morbidity. `Grade 4' problems regional anaesthesia (0.23% vs 0.05%), in contrast to other
are associated with a fatal outcome. (non-equipment related) problems, where the frequency was
826
3. Equipment problems during anaesthesia
Table 1 Patient characteristicsÐ83 154 anaesthetics
Regional anaesthetics General anaesthetics All anaesthetics
n % n % n %
Age 0±20 yr 308 1.5 17 357 27.7 17 665 21.2
Age 20±60 yr 9598 46.7 31 974 51.1 41 572 50.0
Age >60 yr 10 658 51.8 13 259 21.2 23 917 28.8
ASA I 5401 26.3 21 079 33.7 26 480 31.8
ASA II 9128 44.4 27 718 44.3 36 846 44.3
ASA III 5197 25.3 9646 15.4 14 843 17.9
ASA IV 826 4.0 3923 6.3 4749 5.7
ASA V 12 0.1 224 0.4 236 0.3
General surgery 4804 23.4 18 130 29.0 22 934 27.6
Orthopaedic surgery 13 122 63.8 13 319 21.3 26 441 31.8
Neurosurgery 18 0.1 3881 6.2 3899 4.7
Gyn/Obst surgery 1956 9.5 13 256 21.2 15 212 18.3
Other 664 3.2 14 004 22.4 14 668 17.6
All anaesthetics 20 564 100.0 62 590 100.0 83 154 100.0
Downloaded from http://bja.oxfordjournals.org by on August 2, 2010
Table 2 Frequency and severity of problems. Higher frequency of equipment problems during general anaesthesia compared with regional anaesthesia, but
increased frequency of `other problems' during regional anaesthesia (*P<0.01)
Regional anaesthetics General anaesthetics All anaesthetics
n % n % n %
Equipment problems
Severity Grade 1±2 10 143 153
Severity Grade 3 0 4 4
Severity Grade 4 0 0 0
Total 10 (0.05)* 147 (0.23)* 157 (0.19)
Other problems
Severity Grade 1±2 3492 (17.0) 9671 (15.4) 13 163 (15.8)
Severity Grade 3 39 (0.2) 343 (0.5) 382 (0.5)
Severity Grade 4 0 54 (0.1) 54 (0.1)
Total 3531 (17.2)* 10 068 (16.1)* 13 599 (16.4)
All problems 3541 (17.2) 10 215 (16.3) 13 756 (16.5)
All cases 20 564 62 590 83 154
slightly higher during regional anaesthesia (17.2% vs detected. In one case, the non-invasive arterial pressure
16.1%). readings were falsely high, and the patient received a large
dose of volatile anaesthetic, while the patient in reality was
severely hypotensive. In two cases the cardiopulmonary
Severity of equipment problems bypass machine was involved: in one there were mis-
As presented in Table 3, most equipment problems (n=112) connection and oxygenation problems; in the other case the
were trivial (Severity Grade 1). About one-quarter (n=41) system was primed incorrectly. All these problems involved
were of intermediate severity (Severity Grade 2), and four elements of human error.
were serious (Severity Grade 3). All the serious problems
and 29 of the intermediate problems affected the patient to
some degree (Table 4), but no patient suffered any lasting Types of equipment involved (Table 3)
morbidity or needed prolonged postoperative care. One-third of the problems (49/157) occurred with the
In four cases, the problems were judged as serious anaesthesia machine, with the most common problem being
(Severity Grade 3). In one case the ventilator was inadvert- leakage from, and misconnection of, the breathing system
ently turned off during anaesthesia. This was a new (n=24). Other problems included gas leakage from the
anaesthetic machine, where the `power button' protruded vaporizer±machine connection (n=7), leakage in the venti-
from the cabinet, and it was inadvertently pushed by the lator (n=8), and malfunction of the one-way valve.
anaesthetist. The ventilator stopped and the patient's pulse The majority of other problems occurred with invasive
oximeter reading decreased to 45% before the error was and non-invasive arterial blood pressure monitoring
827
4. Fasting and Gisvold
Table 3 Type of equipment involved and severity of problem
Equipment involved Severity Severity Severity Total equipment
Grade 1 Grade 2 Grade 3 problems
n n n n
Anaesthesia machine 26 22 1 49
Invasive arterial pressure 14 4 18
Non-invasive arterial pressure 14 1 1 16
Gas analyser 12 12
Other monitor 8 2 10
ECG 10 10
Cardiopulmonary bypass machine 5 2 7
Pulse oximeter 7 7
Endotracheal tube 4 1 5
Infusion pump 4 1 5
Temperature measurement 4 4
Capnograph 3 1 4
I.V. access 1 1 2
Central venous pressure 2 2
De®brillator 1 1 2
Blood warmer 1 1
Chest drain 1 1
Laryngoscope 1 1
Downloaded from http://bja.oxfordjournals.org by on August 2, 2010
Urometer 1 1
Total 112 41 4 157
Table 4 Untoward effects on the patient caused by equipment problems
Equipment involved Problem Effect on patient n
Anaesthesia machine Misconnection Hypoxaemia 5
Ventilation problems Hypoxaemia 2
Low ¯ow in Mapleson±D system Hypercapnia 2
Valve occlusion High airway pressure 1
Power supplyÐventilator stopped Hypoxaemia 1
Adult equipment to child Hypercapnia 1
Vaporizer failure Hypotension 1
Cardiopulmonary bypass machine Short stops from various causes Hypoperfusion, short periods 7
Non-invasive arterial pressure Error in measurement Undetected hypotension 4
Invasive arterial pressure False low pressures Unnecessary pressor treatment 3
Infusion pump Malfunction Drug overdose, hypotension 2
Urometer Occlusion in set Unnecessary ¯uids and diuretics 1
De®brillator Failure to shock Delayed treatment 1
I.V. access Disconnection Hypovolaemia, hypotension 1
Chest drain Disconnection Lung collapse 1
Total 33
equipment, and other monitoring equipment. Most of the users (Table 5). Twenty-nine of the problems concerned the
problems with invasive arterial blood pressure equipment anaesthesia machine, and of these, 18 were related to
represented low readings from a radial artery cannula inadequate pre-use checks. Most of these errors occurred
compared to the aortic cannula during cardiac surgery. when the anaesthesia machine was checked between cases,
However, measurement errors, drifting, and cable failure rather than at the start of the day. Contributing factors were
also occurred. Non-invasive arterial blood pressure equip- `last-minute changes' because of a change in schedule
ment failure was also common, and related to technical (change in type of breathing system, ventilator, or type of
failureÐincluding leaks from the tubing and cuff. Other anaesthesia).
problems related to malfunction of other monitors, and
malfunction of the cardiopulmonary bypass machine during
cardiac surgery.
Continuous quality improvement
No trends were noted in the rate of occurrence of equipment
Human error problems between 1996 and 2000. In the same period, we
About one-quarter of the equipment problems (n=40) were recorded an increased occurrence of other problems
considered to be related to human error on the part of the (Table 6).
828
5. Equipment problems during anaesthesia
Table 5 Human errors contributing to equipment problems
Equipment involved Problem n
Anaesthesia machine Misconnected patient systems 13
Undetected leakage from patient systems 5
Wrong gas ¯owÐpatient system 2
Power accidentally turned off 1
Vaporizer leakageÐafter changeover 6
Other 2
Non-invasive arterial pressure False normal readings, delayed detection of low arterial pressure 3
Invasive arterial pressure False low readingsÐtreated with vasopressor 3
Cardiopulmonary bypass machine Misconnection and wrong priming of system 2
Endotracheal tube Kinked tube, not checked, bronchodilators given 1
Laryngoscope Low batteries, no spare immediately available 1
Chest drainage DisconnectionÐwrong connectors used 1
Total 40
Table 6 Variation in occurrence of problems from 1996 to 2000. There was no change in frequency of equipment problems, but an increase in frequency of
other problems
1996 1997 1998 1999 2000 Trend P-value
Downloaded from http://bja.oxfordjournals.org by on August 2, 2010
Equipment problems 45 25 29 25 33 No change 0.25
Other problems 2644 (15.5%) 2730 (16.0%) 2726 (16.5%) 2645 (17.3%) 2854 (17.1%) Increase <0.001
Cases per year 17 023 17 020 16 544 15 829 16 738
Discussion and a nurse are involved in every case. The recording has
been part of departmental routine for 15 yr, and de®nitions
Having prospectively recorded problems in 83 154 cases of
anaesthesia, we found equipment problems to be rare, and of and severity assessment are continuously discussed in
departmental meetings. Consequently, we believe that the
low severity. Human errors (for example failure to check
agreement between observers is good. We also believe that
equipment and man±machine interaction failure) were
the total frequency of problems and the frequency of
important factors, in addition to `pure' equipment failure.
equipment problems are representative of the occurrence of
The low frequency of equipment problems limits its
these problems in our practice, and are a result of routines
usefulness as a numerical quality indicator. However,
for checking and maintenance of equipment in the depart-
analysis of patterns and causes of these problems can be a
ment, and routines for follow-up when problems occur.
useful part of a quality assurance programme in a depart-
ment.
Frequency and severity of equipment problems
Methodology Four studies have been published representing mandatory
In all incident reporting, under-reporting is a potential reporting, with data recorded from all anaesthetic cases.8±11
problem. This is related to the added workload from Our results are of the same magnitude as those of Cohen and
completion of forms, a belief that reporting is of limited colleagues8 who found an incidence of 0.1±0.4% for
value, and fear of consequences of reporting.14±17 We equipment problems in 27 184 cases of anaesthesia from
believe that the reporting compliance in our study is good. four different hospitals. In that study, a check-off form was
All patients receiving an anaesthetic were followed, and completed for every patient, and 18 types of intraoperative
included in the study. The incidents were recorded in a problems were included in the data set. However, severity
prospective manner, and as information from all cases was was not assessed. The frequency of total problems varied
included, important events were less likely to be missed. from 14.9% to 27.8% amongst the four hospitals.
This is in contrast to studies where information is collected Three studies have been published from a large German
only from selected samples of patients. quality assurance project concerning perioperative incidents
Our system is designed to add minimal workload, as all (both operating room and recovery room).9±11 Data were
recording is done directly on the anaesthetic chart, and no collected from all anaesthetics, 63 types of incidents and
additional form is needed. We are using the data actively in ®ve levels of severity were de®ned. The frequency of
the department, for problem discussions and quality equipment problems was 0.7% in 18 350 cases,9 0.9% in
projects, and we have created a non-punitive attitude 26 907 cases,10 and 1.2% in 96 000 cases.11 The frequency
towards the occurrence of problems.12 All cases are of all problems was 23.2%, 27.9% and 22% respec-
recorded, the recording is obligatory, and both a physician tively.9±11 We found a lower occurrence of total equipment
829
6. Fasting and Gisvold
problems and total problems than in the German studies. quarter of cases, and most of these involved the anaesthesia
The cause of this is dif®cult to discern, as the German machine. The main cause was insuf®cient checking of the
studies included the whole perioperative period and the anaesthesia machine before use, especially between cases.
intraoperative problems are not reported separately. In This was also shown by Short and colleagues.19 The
addition, de®nitions and classi®cations were different. problems often occurred as a consequence of `last-minute
Finally, there is of course a possibility of differences in modi®cations', when breathing systems and vaporizers were
problem occurrence, reporting compliance, or both. How- changed after the checking procedure had been performed.
ever, the general conclusions from these and our studies are To reduce the possibility of human error causing
similar, as equipment problems were rare and of low equipment problems a three-level approach has been
severity, but some had untoward effects on patients, without suggested: (i) when possible, equipment should be designed
causing any lasting morbidity. These problems do carry a such that the possibility of human error is minimized; (ii) if
potential for serious adverse outcome, and preventative human error cannot be prevented, systems should be
measures are important.1 3 7 9 18 designed to minimize the injury caused by such errors;
Other studies have collected data by voluntary reporting (iii) if neither of the previous safety approaches is possible,
only of problem cases. The overall problem ®gures are the system should be equipped with monitors and alarms to
generally lower, as under-reporting is well recognized.16 17 alert the user of an adverse condition that may be caused by
Short and colleagues5 reported a frequency of 0.23% of equipment failure or change in the patient's condition. This
equipment/breathing system problems in 16 379 anaes- approach is an example of a `systems' approach to error
Downloaded from http://bja.oxfordjournals.org by on August 2, 2010
thetics, but an overall problem rate of only 0.76%. Spittal management, where the working environment of the
and colleagues4 reported a 2% incidence of equipment- anaesthetist is optimized to avoid errors.20 21
related problems in 5056 cases, with an overall problem rate
of 6.68%. The case mix, routines for preoperative checking
of the anaesthesia machine, and level of maintenance of Continuous quality improvement
other equipment, were not speci®ed in these studies. We found no change in occurrence of equipment problems
during the period of our study, while there was an increasing
trend for other problems. However, the low rate of
Type of equipment involved equipment problems limits statistical appraisal, as variation
The anaesthesia machine, including the breathing system, may be the result of chance. The low rate of equipment
was the most common cause (31%) of equipment problems problems also limits its use as a continuous quality
in our study. This was also the most common cause in the indicator, as changes in occurrence caused by efforts to
studies by Bothner, Georgieff and Schwilk (30%),11 and improve are dif®cult to separate from natural variation.
Schwilk and colleagues (22%).10 Also, in other incident Therefore, the most suitable analysis of these data may be as
studies where the denominator is not known,1 4±6 problems `sentinel events', where problems are analysed individually,
related to the anaesthesia machine were most common, or in groups, to elucidate causative factors and preventative
ranging from 52 to 73%. measures, rather than a numerical approach.
We found most of the anaesthesia machine problems to The low rate of equipment problems recorded indicates
be related to the breathing system, as has been found in that our routines for use, checking and maintenance of
other studies where this information is supplied.1 4±6 The equipment are adequate. However, there is still a potential
breathing system is often reconnected for cleaning and for serious problems, and strategies to prevent human error
change of system between patients, and this may predispose should be implemented as this contributed to a quarter of
it to errors, despite the routines for checking the machine at problems. In addition, an improved check between cases
the start of the day. may reduce the occurrence of equipment problems with the
Non-invasive and invasive arterial pressure measure- anaesthesia machine, which was the main cause of prob-
ments were involved in many of the equipment problems. lems.
This equipment has many potential problems, and readings Ideally, follow-up of problems as part of continuous
may not be correct. This predisposes it to errors, and our quality improvement efforts should lead to a decreased
®ndings are a reminder that numbers from invasive and non- problem frequency. Short and colleagues19 studied
invasive automated arterial blood pressure measurement improvements in anaesthetic care resulting from a critical
should be constantly evaluated against the patient's clinical incident reporting programme, but found no change in
condition. incidence of problems. However, the programme was
considered effective in detecting latent system errors.
Changes in the frequency of problems may be explained
Human error as a result of quality-related activities in the department, but
Human error and misuse of equipment have been shown to also changes in reporting compliance, or changing anaes-
be more common than `true' equipment failure.3 5 In our thesia practice may in¯uence the results. A routine-based
study, human error was the main contributing factor in one- recording system will give us the possibility of evaluating
830
7. Equipment problems during anaesthesia
problem rates, as the total number of anaesthetics is known, 8 Cohen MM, Duncan PG, Pope WD, et al. The Canadian four-
but care must be taken when the occurrence is rare. centre study of anaesthetic outcomes: II. Can outcomes be used
to assess the quality of anaesthesia care? Can J Anaesth 1992; 39:
430±9
Conclusion 9 Schwilk B, Muche R, Bothner U, Goertz A, Friesdorf W,
Georgieff M. Quality control in anesthesiology. Results of a
With our checking and maintenance routines, we found prospective study following the recommendations of the
equipment to cause few problems, both related to number of German Society of Anesthesiology and Intensive Care.
cases (0.19%), and related to the occurrence of other Anaesthesist 1995; 44: 242±9
problems during anaesthesia (1.1%). Human factors were 10 Schwilk B, Muche R, Treiber H, Brinkmann A, Georgieff M,
important causes of problems, and the anaesthesia machine Bothner U. A cross-validated multifactorial index of
was most often involved. Although we recorded no perioperative risks in adults undergoing anaesthesia for non-
morbidity from equipment problems in 83 154 cases, both cardiac surgery. Analysis of perioperative events in 26 907
anaesthetic procedures. J Clin Monit Comput 1998; 14: 283±94
this and other studies have indicated that a potential for
11 Bothner U, Georgieff M, Schwilk B. Building a large-scale
equipment-related morbidity exists. The type of data perioperative anaesthesia outcome-tracking database:
retrieved from our analysis provides valuable information methodology, implementation, and experiences from one
for departmental quality projects. provider within the German quality project. Br J Anaesth 2000;
85: 271±80
12 Fasting S, Gisvold SE. Data recording of problems during
Acknowledgements
Downloaded from http://bja.oxfordjournals.org by on August 2, 2010
anaesthesia: presentation of a well-functioning and simple
The study is supported with grants from the Norwegian Medical Research system. Acta Anaesthesiol Scand 1996; 40: 1173±83
Council. 13 Rosner B. Chi-square test for trend in binomial proportions. In:
Fundamentals of Biostatistics. Paci®c Grove, CA: Duxbury Press,
2000; 397±400
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