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 Ramajeyam Om 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 (Dyer C. Br. 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 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 M ay 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 M ay 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 6 th 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 Room As 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 ● % 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 )