Chief CRNA: Building a Safe OR Environment

The model for Healthcare delivery in the United States has evolved from a paternalistic, volume based approach through an era of shared responsibility and now into a consumer driven value based model.  To remain competitive in today’s healthcare market, hospitals and providers must strive for patient safety and satisfaction in the delivery of patient care.  Creating and maintaining a safe environment is foundational to patient safety.

Writing in the Healinghealth.com blog, Susan Mazer writes about the importance of a clean and safe hospital environment.  She notes “The patient environment of care plays a vital role in the discipline of patient safety for every hospital. Demonstrating that the hospital is a safe place for patients and for those that work there should be of the utmost importance for all health care personnel.”  She goes on to list 5 steps for improving patient safety by improving the environment.  Below, are the 5 points from the original article modified to the anesthesia environment.

  1. Remove Equipment from Public areas:   As anesthetists, we are well aware of equipment that is stored in the hallways .  Not only does this extra equipment block the walkways, but it also increases the risk of tripping and makes cleaning more difficult.   Work with others in the OR suite to return excess equipment to the proper place and keep the halls free from clutter
  2. Minimize clutter within the operating room:  Extra monitors, pumps, warmers etc stored behind the anesthesia machine or cart limits your ability to move within the room and increases the risk for tripping.  Excess equipment also reduces your ability to clean between cases and increases the infection risk.  As above, return all excess equipment to the proper place before starting your case.
  3. Organize your cart and machine work space:  Everything needs to be seen and immediately available before starting the case.  Organize your work space the same way for every case so you know where to look for any drug or piece of equipment.  Have a place for drugs, airway equipment and paperwork so that each is readily available.
  4. Inspect your  workspace and monitors for cleanliness:  Don’t rely on housekeeping to get it right.  Look for residual blood or body fluids on your equipment and re-clean them if necessary.  Patients expect and deserve a clean environment that protects them from infection
  5. Minimize auditory clutter:  OK, music is great but it’s not the main event in the operating room.  Patient centered care requires the provider to be able to hear monitors, alarms and be able to communicate with the surgeon.   Keep the noise low and develop a “sterile cockpit” attitude during induction and emergence.

Developing and maintaining a safe environment involves more than the anesthetist.  The entire operating room crew must be on board and work together to ensure a clean, clutter free environment that promotes patient safety.

Clinical Topic: Effects of Anesthesia in Children

Anesthetists in locations ranging from community hospitals to large Children’s hospitals are frequently given the opportunity to anesthtize children of all ages.  Three recent studies were recently reviewed by Karen Blum in Anesthesiology News (JANUARY 2013 | VOLUME: 39:1) looking at the effects of anesthesia on children.

Researchers presenting studies at the 2012 International Assembly for Pediatric Anesthesia found that children exposed to general anesthesia before age 1 were 4.5 times more likely to develop a learning disability.  From Anesthesiology News:

“We have kids who are born otherwise healthy who come in for minor procedures, and we like to think they would wind up all right, But after accounting for variables including race, sex, maternal and paternal education, domestic living arrangements and afterschool activities, the only significant predictor of formally diagnosed learning disability was previous exposure to GA.”

The authors recommend looking at alternative methods of anesthesia such as propofol or regional anesthesia to reduce the exposure of small children to general anesthesia.

A second article in the series noted that children who have surgery tend to return for more surgery increasing the number of exposures to general anesthesia

The final article in the trilogy noted that children receiving Sevoflurane anesthesia had significantly higher lactate levels in the brain which increases brain activity and increases the likelyhood of anxiety or delirium upon emergence from anesthesia.

The review of the three articles was brief and well written in the posting by Karen Blum.

Click here to view the original article as published in Anesthesiology News

 

Opioid-Induced Respiratory Depression

The Anesthesia Patient Safety Foundation is committed to the safe and reliable administration of every anesthetic.  An area of concern has been respiratory depression in the immediate postoperative period secondary to narcotic administration.  The following information comes directly from the foundation;

The APSF believes that clinically significant, drug-induced respiratory depression in the postoperative period remains a serious patient safety risk that continues to be associated with significant morbidity and mortality since it was first addressed by the APSF in 2006.1 The APSF envisions that “no patient shall be harmed by opioid-induced respiratory depression in the postoperative period,” and convened the second multidisciplinary conference on this serious patient safety issue in June of this year in Phoenix, AZ, with 136 stakeholders in attendance. The conference addressed “Essential Monitoring Strategies to Detect Clinically Significant Drug-Induced Respiratory Depression in the Postoperative Period.”

Click here to read the full report by the APSF regarding drug-induced depression in the postoperative period.  After reading the report, click the back arrow to return to this site and leave a comment for your colleagues.

Cost Effectiveness Evaluation of Anesthesia Providers

Anesthesiologists and certified
registered nurse anesthetists
provide high-quality, efficacious
anesthesia care to the U.S.
population.

This research and analyses
indicate that CRNAs are less
costly to train than anesthesiologists
and have the potential for
providing anesthesia care efficiently.

Anesthesiologists and CRNAs
can perform the same set of
anesthesia services, including
relatively rare and difficult procedures
such as open heart
surgeries and organ transplantations,
pediatric procedures,
and others.

CRNAs are generally salaried,
their compensation lags behind
anesthesiologists, and they
generally receive no overtime
pay.

As the demand for health care
continues to grow, increasing
the number of CRNAs, and permitting
them to practice in the
most efficient delivery models,
will be a key to containing costs
while maintaining quality care.

Read the Full article in Nursing Economic$, 2010;28(3):159-169.