Sri Ramajeyam

Om Anandamayi Chaithanyamayi Sathyamayi Parame!

Dr. S. Ahanatha Pillai, M.D.,D.A.,

Emeritus Professor

The Tamil Nadu Dr. M.G.R.

Medical University. Chennai

Former Professor of Anaesthesiology

Madurai Medical College

Sri Ramajeyam

Om Anandamayi Chaithanyamayi Sathyamayi Parame!

Dr. S. Ahanatha Pillai, M.D.,D.A.,

Emeritus Professor

The Tamil Nadu Dr. M.G.R.

Medical University. Chennai

Former Professor of Anaesthesiology

Madurai Medical College

DEPARTMENT OF ANAESTHESIOLOGY

Madurai Medical College, Madurai

Sri RamajeyamOm Anandamayi Chaithanyamayi Sathyamayi Parame!

‘Patient Safety’

Are we following the Standards ?

Self Analysis

Assessment of ‘Safety profile’

Am I well prepared ? Am I well equipped? (Do I have everything ready to meet the

challenges on my way ?)

‘Yes’ – Very Good Safety Profile

Discuss

Less Technical aspects

More of Professional ..

Ethics Discipline Responsibilities

“Eternal vigilance is the price of safety”

Basic principle

Safety standards formulated Monitors - designed & built

Patient Safety

Definition:

Actions taken by individuals and

organizations to protect patients

from being harmed by the effects

of health care services

In Anaesthesia

“Actions taken by Anaesthetist and

Hospital administrators to protect

patients from being harmed by the

effects of Anaesthesia”

Anaesthesia has

No Primary Therapeutic Purpose !

There are No

Safe Anaesthetic Drugs or

Safe Anaesthetic Techniques,

but there are only …

Safe Anaesthetists !

- M H. King

“It is not

the drug that is dangerous, but

the man who administers it is”

- Sir Robert Macintosh

Anaesthetic Accidents - Causes

Human errors Lack of vigilance Distractions Fatigue Inexperience Inadequate supervision Failure of communications Drug reactions & Equipment failure

Accidents

“Anaesthetic accidents hardly

ever happen without warning”

The combination of causes or

sequence of failures that cause

an accident may indeed be unique,

but the mistakes are common

Attitude

“All Anaesthetists, however experienced and however accident - free, should be humble enough to realise and understand that they may make mistakes in any part of their work”

These errors may be in technique, judgment or simply failure of vigilance

- John Alfred Lee

Fatigue “The Anaesthetist has to be prepared to face the unexpected and be alert”

Commonsense says, a reasonable amount of sleep & rest is necessary before taking up a patient’s life into his hands

- John Alfred Lee (D yer C . B r. Med. J.1989)

Ten Golden Rules

● Assess & Prepare the patient well

● Starve him - even for L. A.

● Anaesthetise him on a tipping table

● Check your drugs & equipments

● Keep an effective suction ready

Ten Golden Rules ..

● Keep his airway clear

● Be ready to control his ventilation

● Have a vein open

● Monitor his Pulse and B.P.

● Always keep an assistant who can

apply cricoid pressure

Comparing Anaesthesia

Flight of an Aircraft

Takeoff Flying Landing

Induction Maintenance Recovery

● > 90 % aircraft accidents during landing

● > 80 % anaesthetic accidents during recovery The Anaesthesia Safety Foundation. USA 1980

The Australian Patient Safety Foundation first reported in 1988. Confidential Enquiry into Perioperative Deaths (CEOPD) in UK in 1987

In this comparison

Both are not entirely safe

Time & the rate of accidents

Nothing else is similar

Here only the patient is at risk

Emphasis is “Preparedness”

Cockpit check by Pilot

Before induction, Check Anaesthetic machine Drugs Monitors Accessories

Are we doing it every time ?

Preparation

Legal Responsibility

Anaesthetist is legally responsible

for functioning of the equipments

he uses and the drugs he gives

“A high index of suspicion”

Pre-op Assessment

● Careful physical examination

● Necessary Basic investigations

● Identify pre-existing diseases

● When possible correct them

Are we doing it always?

Grading the “Risk”

Anaesthetist only Grades “Risk”

Consider risk factors

● Patient’s condition

● Choice of anaesthesia

● Proposed Surgery

Who else can give fitness ?

Cardiologist Diabetologist

They may not comprehend the specific problems of anaesthesia

May advise therapy for correcting

specific problems – Not fitness

Choosing the Technique

“Surgeon should not demand or insist on a particular technique of anaesthesia, as he may not know the limitations of the technique or the capability of the anaesthetist to manage the particular technique”

- John Alfred Lee

May prove fatal

Pre-op Starvation

● Even for L A or Day case

● Vomiting & fatal aspiration

Human Assistance

Skillful assistant (O.T Assistant)

● Securing I.V. line

● Getting necessary drugs

● Intubation

● Renders help throughout

Anaesthesia and Recovery Most important & vital for Safety

Basic Monitors

Every Operation Table

● Pulse oximeter

● Non invasive B.P.

● E.C.G. Monitor

● Capnograph

Human Monitor

“No monitor can ever replace

a human being as, he has

the 6th sense”

“Continuous presence of an

anaesthetist is essential to monitor the patient”

- Eichhorn J. H.

Care during Recovery

“All the intensive care given to the patient during intra-operative period is only to be totally abandoned in the immediate postoperative period”

- Wylie W D

“The safest place

for patients to recover is

the operating theatre itself”

Michael B. Dobson

Recovery RoomAs per the standards

Space Personnel

Monitors

Equipments

Do we have it always ?

Transfer to P.O. Ward

Not in a hurry - Only when

● Awake and comfortable

● Adequate Respiration

● Stable C V S

In Anaesthesia

● No mortality is acceptable

● Percentages mean death

● 0.001 % means 1 patient died

● The family suffers 100 % loss

Patients place their ‘Trust’ on us

We are responsible for ensuring their ‘Safety’

Professionally, Morally & Legally

Are we following all the

basic standards of safety ?

If we don’t do it - Why ?

Let us answer honestly

Carry Home Message

● Death due to a disease may

be inevitable, but a death due

to Anaesthesia is a tragedy

- M H. King

Let us prevent such tragedies

Identity of Patient

Check for correctness

● Patient identity

● Informed Consent

● Intended Surgery & Side

Basic Infrastructure

“If we cannot undertake

a clinical responsibility

with proper safety, the only

honest and forthright attitude

must be - not to undertake it”

- A. Lal (IJA 37:1 Editorial - 1989)