![Page 1: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/1.jpg)
Improving Safety in Pediatric Anesthesia in Moldova
Markus SchilyBiel, Switzerland
![Page 2: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/2.jpg)
Is more safety in anesthesia in Eastern Europeneeded?
Who is responsible for it?
Who is going to do it?
![Page 3: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/3.jpg)
Moldova
3.3 mill. people
Anesthesia safety differs in Europe
![Page 4: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/4.jpg)
Motivation, technologies, knowledge
Example1: Children should have anesthesia for TE
Example2: Children should have painfree CC
Example3: Most ped.anesthesia should be combined with a regional block
Intercultural learning
Different Standards:
Progress
![Page 5: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/5.jpg)
A project to improve anesthesia safety
2007: first activities with Moldovan doctors
2008: foundation of IATC
![Page 6: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/6.jpg)
I = Information
A = Assistance
T = Technologies
C = Communication
![Page 7: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/7.jpg)
Driving on the left side?
KEEP LEFT!
![Page 8: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/8.jpg)
Promote empathy, role-play .
Supports students in making the shift in perspective:
own culture becomes a strange, looked at from the outside,target culture becomes familiar.
Wikipedia:
![Page 9: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/9.jpg)
Gradual approach:
I. Identification and understanding of the fundamental values
of the host country
II. Acquisition of the keys needed to decode new situations
III. Adaptation of behaviour
Inter Cultural Learning
![Page 10: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/10.jpg)
Improving Safety - Projects obstacles
Funding?
Language & culture barrier
Ministry of Health: decision maker
![Page 11: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/11.jpg)
Understanding - teaching in 2007 by IATC
![Page 12: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/12.jpg)
Sterile surgery drapes
![Page 13: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/13.jpg)
2012: Moldovan Anesthesia Machines
![Page 14: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/14.jpg)
Who is going to listen to us?
German Ministry of HealthZ31 International Cooperation
![Page 15: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/15.jpg)
Lawrence of Arabia: united the Beduin tribes…
![Page 16: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/16.jpg)
Target governmental funding
introduction of modern drugs and technologies
Strategy:
![Page 17: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/17.jpg)
Ministries of Health
Annual meetings in Moldova Anesthesia Safety
Anesthesia equipment upgrade
![Page 18: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/18.jpg)
Involving societies, find a name of activities
improved anesthesia training
Strategy: Improve communication
![Page 19: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/19.jpg)
Fundraising strategy
Private fundraising
improving means of teaching, humanitarian aid
![Page 20: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/20.jpg)
Initial IATC project in Moldova:
Upgrade of anesthesia equipment
![Page 21: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/21.jpg)
2007: First donated anesthesia machine
![Page 22: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/22.jpg)
Bern 2008 – used anesthesia machines for Moldova
![Page 23: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/23.jpg)
These machines went from Luzern to Moldova
![Page 24: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/24.jpg)
IATC aid to Moldova included:
Budget of about 2 Mill. EUR
More than 80 anesthesia working stations
3 ultrasound machines, 55 syringe pumps
150 hospital beds
Ambulance car
![Page 25: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/25.jpg)
All three children hospitals
fully equiped with new
anesthesia machines
![Page 26: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/26.jpg)
Reduced pediatric anesthesia mortality compared to 2007
ref: MoH Moldova, 2012
First result
![Page 27: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/27.jpg)
Improving communication between societies
WFSA
SARM
![Page 28: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/28.jpg)
ESPA delegate from Moldova
2011 -2013, sponsored and supported by IATC
![Page 29: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/29.jpg)
Commission SARM, MoH, ESA: Reform of anesthesia residency
2010 – 2011, sponsored and supported by IATC
![Page 30: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/30.jpg)
Situation ahead of Anesthesia Reform (before 2011)
1. Pediatric Anesthesia Residency 4 years
(separate Residency)
2. Anesthesia Residency: 4 years
3. Moldovan Syllabus
4. Moldovan oral Exam
![Page 31: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/31.jpg)
Plan of Reform , Anesthesia Residency Moldova, Nov. 2011:
1. Pediatric Anesthesia Residency integrated
2. Residency: 5 years
3. European Syllabus
4. EDAIC exam
![Page 32: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/32.jpg)
Moldovan anesthesia exam result 2012: 100% candidates passing
EDAIC exam Chisinau exam result 2012: 0 % candidates passing
What is wrong?
![Page 33: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/33.jpg)
Corruption
Extra fees to doctors
MC questions: known ahead of exam
Everything can be bought
![Page 34: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/34.jpg)
2012: last 35 anesthesia machines / monitors delivered
New Teaching Concept:
Mobile
Simulation based & clinical teaching
OLA
![Page 35: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/35.jpg)
Mobile Anesthesia Simulation Unit
Curriculum:
Recommendations, guidelines
Crisis management, crew resource management
Rare case management, patient transfer
Simulation cannot replace clinical teaching!
![Page 36: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/36.jpg)
German GiZ funding till end of 2013
Sim baby, Sim 3G man, Sim junior
Ambulance car, transport car
Anesthesia working place
![Page 37: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/37.jpg)
Simulation in Switzerland, 2013
Cardiac arrest afteraspiration
No ECG leads!
![Page 38: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/38.jpg)
ESPA Safety Committee and Simulation:
Joint venture: spread guidelines and recommendations
Pediatric Anesthesia Simulation Course: ESimPA
![Page 39: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/39.jpg)
ESimPA:
1. European network 2. Small mobile teaching teams 3. Inclusion of Eastern Europe4. Coordinating simulation activities with ESPA5. Certification of attendance (ESPA
![Page 40: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/40.jpg)
First steps:
Moldovan project ESPA safety project
TTC for ESimPA tutors
ESimPA tutors: Simulation stage in Swiss and German hospitals
Learning from others: Visitations
![Page 41: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/41.jpg)
Conclusion:
6 yrs.IATC project proved that anesthesia safety differs significantly in Europe
Technical upgrade must be followed by teaching activities
ESPA: key factor in making European pediatric anesthesia more safe
![Page 42: Improving Safety in Pediatric Anesthesia in Moldova Markus Schily Biel, Switzerland](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649db95503460f94aa9fdb/html5/thumbnails/42.jpg)
IATC supports ESPA…
It‘s all about anesthesia safety in Europe
2010 2011