Primum non nocere 1

8/7/2019 Primum non nocere 1

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Primum non nocere

Safe Practice of

Anaesthesia


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The International Scene US Mortality 1950 3:10,000

1990 1:10,000

ASA I & II 1:100,000

General Causes

Human Error + System Failure

Trigger Event + Breakdown in system ofchecks & balances

Judgment Error + Lapse in vigilance


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Factors of Accidents

Environment Ambient conditions/Ergonomics

Equipment Design flaw/User error/Malfunction

Patient Underlying disease

Surgeon Human factors(fatigue/boredom/hunger/tension)

Anaesthesiologist Human Factors

Plan Preuse PAC Planning

& Check Skill

Accommodate Vigilence

I I

Problem Detection

Incident &

Critical Incident Correction

Accident

QUALITY ASSURANCE


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QUALITY ASSURANCETRAINING

DOCUMENTATION

STANDARDS & GUIDELINES

FEEDBACK Postoperative Visit


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MINIMUM MONITORING

STANDARDS1978 Dutch Health Council

1986 ASA

1987 Australian Faculty

1987 CAS

1988 AAGBI

1989 - India


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AAGBI ------ASAo Regular arterial pressure &

HR

o Continuous ECG

o Continuous FI O2 with alarmo O2 supply failure alarm

o VT/MV measurement

o Ventilator disconnectionalarm

o Pulse Oximetero Capnography with trace

o Temp measurementavailable

o Neuromuscular monitoringavailable

Art. Pressure & HR every 5min

Continuous ECG

Continuous FIO2 with alarm Ventilator disconnection

alarm

Pulse oximeter

Capnography

Expired volumemeasurement

Adequate illumination

Temp available

Neuromuscular monitoringavailable


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ISA STANDARDS 99PRE-REQUISITES essential for

functional quality & need to function

BASIC STANDARDS vital foranaesthesia service

DESIRABLE vary depending uponhospital & surgical work


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ISA PRE-REQUISITESProfessional Status Qualified

Facilities & Equipment Resuscitationequipment.

Professional Organisation Anaesth.Forum

Records & StatisticsPersonnel & Workload (transport to

post-op)


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ISA BASICPAC & Protocols

Resuscitation equipment, O2 &Minimum Anaesthesia Equipment

Clinical monitoring colour & pulse

Stethoscope, BP apparatus &

Thermometer basal readingsCardioscope with Defibrillator available

Light source available


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ISA DESIRABLEAll Basic standards

One operable Anaesth. Mc. Per theatre.Should have failure warning facility

Periodically calibrated, drug specificvaporiser

Pulse oxymeter

Major procedures with more monitors


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Delhi AdministrationEQUIPMENT

Absolutely Essential

Essential

Monitoring

Absolutely EssentialPreferable


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DA Equipment

Absolutely Essential Source of O2

Device for ventilation

Airway ET Tubes & Laryngoscope

Suction

OT Table with tilt

Provision for IV infusion

Life saving drugs

Defibrillator

Instrument trolley for equipment & drugs


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DA Equipment

EssentialAbove plus

Anaesthesia Machine (as per specs)

Central pipeline supply

Oxygen analyzer

Equipment for patient monitoringdepending on the setup and type ofsurgery


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DA Monitoring

Absolutely EssentialClinical Monitoring

Continuous monitoring of pulse bypalpation

Frequent measurement of BP

Colour

Movement of chest wall & Reservoir bag

Visual monitoring of blood loss


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DA Monitoring

PreferableContinuous ECG monitoring

Continuous display of PR, BP & ECG

Measurement of SpO2

Measurement ofETCO2

Continuous monitoring of temperature

Specialised monitoring in cases ofprolonged or complicated surgery orwith co-existing diseases


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Ways to GetQuick & Easy

Anaesthesia Machine Rs 60,000 80,000

Vaporiser (Two) Rs 80,000 90,000 each ECG + NIBP BPL, L&T Rs 80,000

SpO2 + CO2 Nonin Rs 90,000

Cardiac Monitor cum Defibrillator BPL Rs 95,000

Anaesthesia Ventilator - Rs 2.5 3Lac


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NET RESOURCES

on SAFETY

Anaesthesia Patient Safety Foundation

www.apsf.org

Institute of Safe Medication Practice

www.ismp.org

National Patient Safety Foundation

www.npsf.org

Documents

Primum non nocere 1