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Presentation transcript:

Recommendations

Patient experience

NAP5 pathway See more at http://www.nationalauditprojects.org.uk/NAP5-Anaesthetia-Awareness-Pathway

NAP5 pathway

Patient experience

Induction

Induction

Induction

Induction - ‘Mind the gap’ checklist

Induction

Maintenance

Emergence

Emergence

Emergence

Obstetrics

Obstetrics

Drug errors – awake paralysis

Reports of AAGA after sedation What should we do about our findings? Recommendations are based on the premise that we all need time to process information and to come to terms with what is an unfamiliar experience. This requires written information reinforced by verbal explanation separated by a period of time for reflection. The explanation should be realistic and not raise expectations that cannot be fulfilled.

What will this feel like? What will I remember? What’s the risk related to the sedation drugs? Not sedated: awake I am awake, possibly anxious. There may be mild discomfort (depending on what I am having done) Everything Nearly zero Minimal sedation I am awake and calm. There may be mild or brief discomfort. Probably everything Very low Moderate sedation I am sleepy and calm but remain in control. I may feel mild discomfort. I might remember some things Low Deep sedation I am asleep, I will not be in control Probably very little Higher risk:My breathing may slow when I am asleep –and I may need help to breathe Anaesthesia I am deeply asleep and unable to respond. Very unlikely to remember anything Higher risk . My breathing may slow or stop and my BP and HR rate may fall. I will need a specialist doctor to look after me Here is a precis of a patient centred explanation. We have suggested a slightly more detailed version of this explanatory table for incorporation into patient literature. A copy is in NAP5 and in your handout.

TIVA

TIVA

NMB 12 recommendations relating to NMBs

Conceptually, unopposed global neuromuscular blockade is an intervention with capacity to cause great psychological harm, unless it is counteracted by general anaesthesia (as evident in syringe swap reports) NAP5 contains reports of paralysis at induction, on transfer into theatre, during surgery, during transfer from theatre, and during recovery. A disruption of the balance can occur at any time during anaesthesia.

NMB 12 recommendations relating to NMBs

DOA

DOA

HF

Medicolegal

Medicolegal

Consent

Consent

Consent

The end