Anesthesia Equipment Safety Flashcards
Anesthesia Hazards
- As an anesthesia provider you purposely render a patient unconscious, breathless and immobile
- you are responsible for the total physiological and psychological being of the surgical patient
IOM “To Err is Human”
- 1999: Building a safer health care system
- Anesthesia mortality rates had decreased from 2 deaths per 10,000 anesthetics in the 1980’s, to 1 death per 200,000-300,000 in the 1990’s
What has contributed to anesthesia success in safety?
- better patient monitoring including pulse ox
- an early focus shift of studying malpractice case to investigating near misses and emphasis on prevention
- adoption of practice guidelines
- anesthesia patient safety foundation (APSF): independent foundation whose sole purpose is to advance safety
AANA Core Values and Motto
Core values:
- Patient safety
- Care for the whole patient, from a nursing perspective
- Professional excellence and personal well-being
- Healthcare policy and collaboration
- Integrity and quality in all professional and clinical settings
Motto: SAFE and effective anesthesia care
What defines safe anesthesia care?
- Anesthesia is not curative in nature: maintain physiological homeostasis as you get patient through surgical event
- Prevention of patient harm: risk vs. benefit
How will you develop an anesthesia practice that puts patient safety first?
- Adhere to National and Organizational Standards and Guidelines
- Be safety leaders
- Maintain competencies through NBCRNA
APSF Critical Anesthesia Requirements: To avoid preventable patient injury through execution of procedures designed to assure the proper function and presence of critical anesthesia equipment requirements including: (7)
- Reliable delivery oxygen at any appropriate concentration up to 100%
- Reliable means of positive pressure ventilation
- Backup ventilation equipment available and functioning
- Controlled release of positive pressure in the breathing circuit
- Anesthesia vapor delivery (if intended as part of anesthetic plan)
- Adequate suction
- Means to conform to standards for patient monitoring
Blair’s Addition to APSF Requirements
- Means to perform ACLS, PALS including the prescence of emergency airway equipment, emergency drugs, and immediate availability of defibrillation
- In the event of anesthesia equipment failure, patient cardiac arrest can ensue
To perform a safe anesthetic You MUST: (6)
- Be able to manually ventilate. The circuit or bag and mask device must be able to give positive pressure AND also release that pressure so the patient can exhale
- Be able to give 100% oxygen at any time
- Monitor the patient (AANA standard IV: ETCO2, SaO2, BP, ECG, Temp, NMT)
- Have working high suction (NO SUCTION, NO INDUCTION)
- Keep the patient asleep (IV or vapor)
- ACLS, PALS, emergency drugs, airway, Defib
Mneomnic for safe anesthetic
M: Manual Ventilation device O: Oxygen M: machine check, monitors S: suction A: airway (check blade, light,) I: IV- placement and drugs D: drugs and defibrillator
AANA Standards (1-6)
- Perform and document a pre-anesthesia assessment and evaluation
- Obtain and document consent
- Formulate a specific patient plan for anesthesia care
- Implement and adjust the plan based on physiological status. Intervene as required to maintain patient in optimal physiologic condition
- Monitor and evaluate and document physiologic condition
- Document anesthesia related information in the patients medical record in a complete, legible, and timely manner
AANA Standards (7-10)
- Adhere to appropriate safety precautions as established within the practice setting to minimize the risks of fire, explosion, electrical shock and equipment failure
- Adhere to infection control
- Participate in ongoing review and evaluation of quality anesthesia care
- Respect and maintain the basic rights of patients
AANA Standard V: Patient monitoring: Ventilation
Monitor ventilation continuously
- verify intubation of trachea by auscultation, chest excursion, and confirmation of carbon dioxide in the expired game
- continuously monitor ETCO2 during controlled or assisted ventilation, including any anesthesia or sedation technique requiring artificial airway support
- use spirometry and ventilatory pressure monitors as indicated
AANA Standard V: Patient monitoring: Oxygen
Monitor oxygenation continuously by clinical observation, pulse ox, and arterial blood gas if indicated
AANA Standard V: Patient monitoring: CV
Monitor CV status continuously via electrocardiogram and heart sounds
-record BP and HR at least every 5 minutes*
a lot more frequently during induction
