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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:
1. Patient safety
2. Care for the whole patient, from a nursing perspective
3. Professional excellence and personal well-being
4. Healthcare policy and collaboration
5. 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)

1. Reliable delivery oxygen at any appropriate concentration up to 100%
2. Reliable means of positive pressure ventilation
3. Backup ventilation equipment available and functioning
4. Controlled release of positive pressure in the breathing circuit
5. Anesthesia vapor delivery (if intended as part of anesthetic plan)
6. Adequate suction
7. Means to conform to standards for patient monitoring


Blair's Addition to APSF Requirements

1. Means to perform ACLS, PALS including the prescence of emergency airway equipment, emergency drugs, and immediate availability of defibrillation
2. In the event of anesthesia equipment failure, patient cardiac arrest can ensue


To perform a safe anesthetic You MUST: (6)

1. 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
2. Be able to give 100% oxygen at any time
3. Monitor the patient (AANA standard IV: ETCO2, SaO2, BP, ECG, Temp, NMT)
4. Have working high suction (NO SUCTION, NO INDUCTION)
5. Keep the patient asleep (IV or vapor)
6. 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)

1. Perform and document a pre-anesthesia assessment and evaluation
2. Obtain and document consent
3. Formulate a specific patient plan for anesthesia care
4. Implement and adjust the plan based on physiological status. Intervene as required to maintain patient in optimal physiologic condition
5. Monitor and evaluate and document physiologic condition
6. Document anesthesia related information in the patients medical record in a complete, legible, and timely manner


AANA Standards (7-10)

7. Adhere to appropriate safety precautions as established within the practice setting to minimize the risks of fire, explosion, electrical shock and equipment failure
8. Adhere to infection control
9. Participate in ongoing review and evaluation of quality anesthesia care
10. 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


AANA Standard V: Patient monitoring: Body Temperature

Monitor body temperature continuously on all pediatric patients receiving general anesthesia and when indicated on all other patients


AANA Standard V: Patient monitoring: Monitor and assess patient positioning

Monitor and assess patient positioning and protective measures, except for those aspects that are performed exclusively by one of more other providers


Safe Anesthesia=

Prevention focus + Back up plan


MAUDE Database

-FDA Manufacturer and User Facility Device Experience
-database houses medical device reports submitted tot he FDA by mandatory reports (manufacturers, importers and device user facilities) and voluntary reports such as HC professionals, patients and consumers


What is considered your lifesaver?

1. Manual ventilation device
2. Means to perform ACLS, PALS, including emergency drugs and immediate availability of defibrillation