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Found 145 results
  1. Content Article
    This study examines the variability in how different anaesthesia providers approach patient care, to provide insight into the source and necessity of variations in practice, the implications of different individual preferences and the subsequent consequences on approaches to safety that emphasise standardisation. The authors argue that the differences in how anaesthesia providers approach their work call into question whether ‘standardisation’ is always the best approach to improve safety in anaesthesia. They state that this work reinforces the idea that it is the humans in the system, with their flexibility and expertise, who are the primary source of everyday safety.
  2. Content Article
    This Twitter thread summarises the views of Dr Ian Jackson, a retired consultant anaesthetist and former Foundation Training Programme Director, on the patient safety and training issues relating to Anaesthesia Associates (AAs). He highlights issues with the length of training AAs receive compared with anaesthetists, the difference in training individuals who have experience in healthcare and theatre roles and those who have not and the supervision model in the current AA scope of practice.
  3. Content Article
    Peripheral nerve blocks (PNB) are safe and effective alternatives or supplements to general anaesthesia. They may improve pain control both during and after surgery, thus avoiding many of the side effects of systemic opioids. PNBs may also lead to improved patient satisfaction, decreased resource utilization, and may be better for the environment by decreasing usage of aesthetic gases and other medications. With the growing use of peripheral nerve blocks in the United States, this paper examines safety issues surrounding the procedures. It examines the safety of nerve blocks as it relates to: nerve injury recognition and treatment of local anaesthetic systemic toxicity (LAST) appropriate health care professional performance of timeouts to avoid wrong-site blocks.
  4. Content Article
    This National Patient Safety Alert has been issued by the NHS England National Patient Safety Team, co-badged by the Association of Anaesthetists, Royal College of Anaesthetists and the Safe Anaesthesia Liaison Group, instructing all relevant NHS funded providers to transition to NRFit™ connectors for all intrathecal and epidural procedures, and delivery of regional blocks. Transition should be completed by 31 January 2025.
  5. Content Article
    Emergence delirium is a temporary but potentially dangerous condition that can occur when a patient awakens after a procedure. In this video, staff at the VA Pittsburgh Healthcare System (VAPHS) share how they implemented a perioperative intervention to reduce the risk of patient and staff harm.
  6. Content Article
    This article in Anaesthesia Critical Care & Pain Medicine aims to provide guidelines to define the place of human factors in the management of critical situations in anaesthesia and critical care. The authors aimed to formulate recommendations according to the GRADE® (Grading of Recommendations Assessment, Development and Evaluation) methodology for four different fields:communicationorganisationworking environmenttrainingThe guidelines produced include a set of recommendations to guide human factors in critical situations.
  7. Content Article
    Antonio Gonzalez speaks to Susan Standford for the Yale Anesthesiology podcast on intraoperative pain. Susanna is a patient who experienced intraoperative pain, and knowing she was not alone, she has actively raised awareness of this issue. In her own words, “Being able to feel major abdominal surgery is every bit as horrific as it sounds.” They discuss neuraxial anaesthesia for CS, guidance on testing and managing blocks, women being labelled ‘anxious’, outcome measures and targets.
  8. Content Article
    This tool is based on the Surgical Safety Checklist developed by the World Health Organization (WHO) in 2009. It should be used at three key transitions in care: Before anaesthesia is given Immediately prior to incision Before the patient is taken out of the operating room The checklist is not intended to be comprehensive, and additions and modifications to fit local practice are encouraged.
  9. News Article
    Undergoing a medical procedure without an anaesthetic felt like being "flayed alive", according to Dee Dickens. The 53-year-old is one of many in the UK who have reported having a hysteroscopy, which is used to examine the uterus, without enough pain relief. Clinical guidelines say patients must be given anaesthetic options before the gynaecological exam. Cwm Taf Morgannwg health board said it was concerned by the experiences of Ms Dickens and urged her to get in touch. Ms Dickens, from Pontypridd, Rhondda Cynon Taf, had a hysteroscopy as an outpatient at the Royal Glamorgan Hospital in Llantrisant after experiencing bleeding despite being menopausal. Ms Dickens said her medical notes and past childhood sexual abuse were not considered and she was not offered a local anaesthetic prior to the procedure in October 2022. Due to underlying health conditions, including fibromyalgia and Ehlers-Danlos Syndromes (EDS), she was reluctant to have a general anaesthetic as it would have left her "poorly for weeks" so she had the hysteroscopy on painkillers only. "Everybody's bustling, so it's really difficult to advocate for yourself," said Ms Dickens. When the procedure began, she said she felt extreme pain, adding: "I was very aware that I was a black woman who felt like she was being experimented on with no anaesthetic. "They took out my coil and then they started on the biopsies and good God, that felt like being flayed alive. It was awful. "It was like having my insides scraped out and blown up all at the same time." Read full story Source: BBC News, 27 November 2023 What is your experience of having a hysteroscopy? Add your story to our painful hysteroscopy hub community thread.
  10. Content Article
    Potentially serious complications occurred in 1 in 18 procedures under the care of an anaesthetist in UK hospitals, according to a national audit by the Royal College of Anaesthetists (RCA). Risks were found to be highest in babies, males, patients with frailty, people with comorbidities, and patients with obesity. Risks were also associated with the urgency and extent of surgery and procedures taking place at night and/or at weekends.  The survey, published in Anaesthesia, was the RCA's seventh national audit project (NAP7) and included more than 20,000 procedures at over 350 hospital sites. NAPs study rare but potentially serious complications related to anaesthesia, and are intended to drive improvements in practice. Each focuses on a different topic and NAP7 examined perioperative cardiac arrest.  Dr Andrew Kane, consultant in anaesthesia at James Cook University Hospital in Middlesbrough and a fellow at the RCA's Health Services Research Centre in London, said the new data presented "the first estimates for the rates of potentially serious complications and critical incidents observed during modern anaesthetic practice". The data confirmed that individual complications are uncommon during elective practice, but highlight the relatively higher rate of complications in emergency settings.
  11. Content Article
    Marsha Jadoonanan, nurse and Head of Patient Safety and Learning at HCA Healthcare UK (HCA UK), spoke to us about a recent opportunity to learn from patient safety incidents involving wrong site anaesthetic blocks. She describes the new learning approach she and her colleagues used, which focused on engaging staff working in a variety of roles to create a safe space to focus on identifying ‘work as done’.
  12. Content Article
    Commercial aviation practices, including the role of the pilot monitoring, the sterile flight deck rule, and computerised checklists, have direct applicability to anaesthesia care. Checklists are commonly used in the operating room, especially the World Health Organization surgical safety checklist. However, the use of aviation-style computerised checklists offers additional benefits. In this editorial, Jelacic et al. discuss how these commercial aviation practices may be applied in the operating room.
  13. Event
    The Safe Anaesthesia Liaison Group (SALG) Patient Safety Conference will be held virtually this year on Thursday 23 November 2023. The first session will include engaging lectures around the current work of SALG, and the second session will focus on topical issues in relation to a selected group or society (yet to be announced). There will be a prize session for accepted abstracts, with a poster section and oral presentations. This online conference is being organised by SALG co-chairs, Dr Peter Young from the Association of Anaesthetists, Dr Felicity Platt, Royal College of Anaesthetists The day will provide valuable knowledge for doctors engaged in clinical anaesthesia, pain management and intensive care medicine, and who have an interest in improving patient safety. Register
  14. Content Article
    A series of podcasts from Molnlycke UK, with host Steve Feast, discussing topics such as sustainability, patient safety and more.
  15. News Article
    Measures for avoiding medication errors with the injectable agents used routinely in anaesthesia care have been recommended in new guidelines from the Association of Anaesthetists. The guidelines, published in Anaesthesia, the journal of the Association of Anaesthetists, were drawn up "in response to requests for guidance from members in view of continuing incidents of medication errors and patient harm." The working party of UK anaesthesia experts that drew up the guidance emphasised the potential safety benefits of using prefilled and labelled syringes, as well as aids such as colour-coded medication trays. It highlighted that these were not yet in widespread use within the NHS. The group noted that unlike many healthcare workers, anaesthetists usually undertook medication preparation (transfer from labelled ampoules into unlabelled syringes) in a solo capacity, and that there could be an average of 10 medication administrations per anaesthetic procedure. Labelling errors have been reported in around 1–1.25% of peri-operative administrations, and medication substitutions in 0.2% of administrations during anaesthesia. The working party, chaired by Dr Mike Kinsella, honorary consultant in the Department of Anaesthesia at University Hospitals Bristol and Weston, said it aimed "to provide pragmatic safety steps" for use within operating theatres, as well as goals for the development of "a collaborative approach to reducing errors" as a basis for "instilling good practice." "It is important to acknowledge that every practitioner is open to error," the authors said, noting that the risk could increase over time during a case, especially if an anaesthetist's performance was diminished by fatigue. Read full story Source: Medscape, 10 August 2023
  16. Content Article
    Peri-operative medication safety is complex. Avoidance of medication errors is both system- and practitioner-based, and many departments within the hospital contribute to safe and effective systems. For the individual anaesthetist, drawing up, labelling and then the correct administration of medications are key components in a patient's peri-operative journey. These guidelines from the Association of Anaesthetists aim to provide pragmatic safety steps for the practitioner and other individuals within the operative environment, as well as short- to long-term goals for development of a collaborative approach to reducing errors.
  17. Content Article
    A recent paper (from clinicians and Human Factors specialists at the Royal Surrey NHS Foundation Trust) jointly supported by Elsevier and BJA Education clarifies what Human Factors (HF) is by highlighting and redressing key myths.  The learning objectives from the paper are as follows: Identify common myths around HF Describe what HF is Discuss the importance of HF specialists in healthcare Distinguish the importance of a systems-based approach and user-centred design for HF practice.  It explains that HF is a scientific discipline in its own right, a complex adaptive system very much like healthcare. Its principle have been used within healthcare for decades but often in an informal way.  A link to the summary of the article on Science Direct and further links to purchase the paper can be found here: https://www.sciencedirect.com/science/article/abs/pii/S2058534923000963?dgcid=author 
  18. Content Article
    Successful day surgery requires a day surgery team with the correct knowledge and skills to enable safe, early recovery and discharge but there is an absence of national guidance on supporting competencies. Applying in-patient competency criteria is inappropriate as this pathway is not aimed at promoting early discharge. This joint publication between AfPP and BADS (the British Association Of Day Surgery) provides recommendations for core competencies for adult day surgery through (1) admission, (2) anaesthetic room, (3) theatres, (4) first-stage recovery and (5) second-stage recovery and discharge. They are relevant for staff new to or after a long absence from day surgery and acknowledge some members of the day surgery team may include non-registered practitioners. All can be used as a reference for workbook competency documents in place or in development.
  19. News Article
    A trust at the centre of a maternity scandal has been failing to meet Royal College standards in one of its maternity units, HSJ can reveal. The duty anaesthetist for the maternity unit at the William Harvey Hospital in Ashford has also had to cover the hospital’s primary percutaneous coronary intervention suite. This could mean no anaesthetist is available to carry out an emergency Caesarean if they are needed to treat a heart attack patient. This goes against Royal College of Anaesthetists’ guidelines, which say a duty anaesthetist must be “immediately available for the obstetric unit 24/7”. The guidelines add that where the duty anaesthetist has other responsibilities – because, for example, they work at a smaller maternity unit where the workload does not justify them being there exclusively – then “these should be of a nature that would allow the activity to be immediately delayed or interrupted should obstetric work arise”. The William Harvey unit is East Kent Hospitals University Foundation Trust’s major birth centre. The trust has around 6,500 births a year – the majority at the WHH – and was heavily criticised for poor maternity care in a report by Bill Kirkup last year. Read full story Source: HSJ. 17 July 2023
  20. Content Article
    Mandy Anderton is a Clinical Nurse specialising in learning disability and a hub Topic Leader. In this new blog, Mandy explains how they are using shared decision making and reasonable adjustments to implement a new care pathway, where patients with a learning disability needing to undergo a medical investigation can receive deep sedation within their own home.  Working with patients, carers, relatives, anaesthetists and others, the aim is to improve access to important medical investigations with minimal distress, where other avenues have been exhausted. 
  21. Content Article
    Doctors are taught from medical school about the benefits of IUDs, and often encourage patients that they are a good contraceptive option. However, recent media attention on the pain that some women suffer when having their IUDs fitted has started conversations about the need for cervical blocks and more honest counselling of women about the procedure. Rebekah Fenton, adolescent medicine fellow at Lurie Children's Hospital of Chicago, joins us to talk about how she counsels her patients, and why the most important thing is to make sure women are in charge of their reproductive healthcare decisions.
  22. Content Article
    Intrahospital transport is a common occurrence for many hospitalised patients. Critically ill children are an especially vulnerable population who experience preventable adverse events at least once a week, on average. Transporting these patients throughout the hospital introduces additional hazards and increases the risk of adverse events. The transport process can be decomposed into a series of steps, each incurring specific risk. These risks are numerous and few of these risks are specific to the transport process. There is a paucity of literature available on paediatric intrahospital transport and related adverse events. Elliot et al. recently reviewed the Wake Up Safe database, a paediatric anesthesia quality improvement initiative across member institutions to disseminate information on best practices, for paediatric perioperative adverse events associated with anaesthesia-directed transport. The authors present several examples of airway and respiratory events taken from the database and discuss the complexity of the transport process.
  23. Content Article
    A gap analysis identified the need for process improvement surrounding the identification and reporting of adverse drug reactions related to moderate sedation. A change to documentation was selected to address this gap. The challenge was disseminating the change in a meaningful way during a time of high census and limited staffing due to the COVID-19 pandemic. Complex adaptive systems theory was used to plan interventions in these conditions.
  24. Content Article
    Safe and Sound is a podcast produced by the Barts Health Education Academy which aims to have honest, informative and educational discussions about patient safety and how it can be improved. In this episode, Dr Charlotte Hopkins, an HIV consultant who works in patient safety and Dr Annie Hunningher, a consultant anaesthetist and patient safety specialist, discuss the pros and cons between two different approaches to patient safety, Safety 1 and Safety 2.
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